bismarck

That is simply not accurate. A surgeon that specializes in one type of procedure exclusively will be better at that procedure just by virtue of experience. Similar to a chef with food. Think Jiro dreams of Sushi. Hair stylist with types of hair -- think inner city barbers. Mechanic with cars. Someone that works only on Teslas all day will be better at Teslas than someone who is a general mechanic. A mixed martial artist might be a better 'fighter' than someone that exclusively boxes, but he will not be a better boxer -- think Conor MacGregor and Mayweather. The analogies are endless. A general surgeon will not perform plastic surgery as well as a plastic surgeon. And a plastic surgeon that exclusively focuses on breast implants will be better at them then one who does all types of plastic procedures. A neurologist will do a better neurology exam on average than an ER doc. An ER doc might think of non neurology things that could be wrong more easily, but when it comes to neuro, the specialist is obviously master of their craft. Increased specialization leads to increased expertise, at least at the one thing that someone does. I'm not saying anything about who is a candidate for what, I am talking about the procedure itself. A surgeon that can do both procedures might give you a more even handed answer about which is right for you, but even then he will have bias for the procedure that he is better at (Feller). Decide which procedure is the best for you, then go to the person who is the best at that procedure.

On some level I appreciate your point, but I don't completely agree for a few reasons: -Someone who does FUT 80% and FUE 20% is usually not going to be as accomplished with either as someone who does FUE 100% or FUT 100%. This is the reason for increasing subspecialization within medicine -- to avoid the jack of all trades, ace of none phenomenon. You don't have to be great at open heart surgery to know how to be a great interventional cardiologist. Being adept with one type of harvesting technique may not give you any advantage with the other. It could even have the opposite effect. -There is a huge variability amongst surgeons regardless of region, though presumably they have similar 'Western' training. I would argue that Couto has surpassed most of the doctors he trained under, probably due to a combination of conscientiousness, technique and god given talent. So comparing docs is a very valid exercise, even if its only based on submitted cases.

Just for kicks, how would you guys compare the top tier American docs for FUE (Rahal, Konior, H&W, Gabel, Diep etc) against the top tier Europeans (Couto, Feriduni, de Freitas, Lorenzo, Feriduni, Bisanga, Erdogan etc)? For yield and to a lesser degree design.

Thanks, I will keep an eye out. I would also love to see a case where one half of the scalp was done with FUE, the other half strip.

Thanks for not answering my question and using my thread to advertise your broke clinic. Anyone else?

That will always be the issue with any therapy that triggers the 'immortal' stem cell. You are at risk of going the other direction. Hair follicles, and for that matter life itself, are a delicate balancing act. There are 2 basic approaches researchers take to try and maintain longevity. -Slow down division rates because with each progressive cycle, the telomeres at the end of the follicle's DNA strand shorten due to the introduction of random mutations during replication. The risk: if you slow down division too much, the cell will die. -Speed up division through the stem cell induction, harvesting/implantation and growth factors, essentially starting from scratch. The risk: you will also trigger or enable aberrant cells to follow the same path, and inadvertently trigger cancer. Also, older follicles may not be able to handle the stress of increased division and fibrose -- the dreaded shock loss that becomes permanent. They are trying stem cell therapy currently with literally almost every disease process out there -- heart disease, Parkinson's, cirrhosis, you name it. The Nobel prize winning question to answer is simple: how to promote the longevity and growth of the cells *we want* while scavenging and removing the cells that will hurt us when left unchecked. We are not even past the first step of this process, we can't even consistently get the cells we want. Very few scientists have started thinking forward to the second step because the first step is so massive. My hunch is that molecular and atomic transistors will be the missing link for most of these issues. Imagine an intelligent follicular extraction that used microstaining or spectroscopy to determine exactly how large the bulbar stem cell was at the dermal papillae, instead of this blind stabbing or lawnmower strips. It will make the most detailed and delicate work of today look like savage butchery. More subtle work such as dividing stem cells so as not to lose donor density would be the logical next step. If Replicel is successful, its creators will not only revolutionize hair loss, but also literally reset all of sports medicine. Tendons and cartilage share many of the same issues as hair follicles with aging.

Could someone kindly direct me to this post? I have seen it referenced on a few threads, but I can't find the actual cases.

What a weird post

His waiting list has gone up to 6 years

This is not the first time I've seen something like this from big B. No bueno.

If you're not a physician that surgically treats hair loss, it can be hard to leverage your field of practice into hair restoration as it is such a niche specialty. Ultimately, the proof is in the pudding. Instagram followers and google reviews are not as reliable as actual patient cases, particularly as the Turkish clinics seem to have a habit of inflating their numbers artificially. There have even been scenarios here where a clinic was suspected of making multiple HRN accounts. Not across the board, but I've seen fishy behavior from that neck of the woods more than once. Though obviously it is too late now, good questions to ask early are: do they have a large quantity of patient (not clinic) submitted results here or elsewhere online? Do they have big failures? How do they respond to their failures? Then you can get into the specifics like: how much of the procedure is performed by techs, do they use manual or robotic punches, how long have they been in practice, do they subcontract techs or are they contracted employees, where did the doc train and in what specialty (ENT, ER, general practitioner, etc), what's their volume and FUT/FUE split, etc.

Keep us updated and good luck.

From what they've put out so far, I wouldn't expect effective clinical therapy to become available sooner than 10-15 years down the road in a best case scenario. Stem cell therapy has been the most promising frontier of hair loss research for awhile, but that's all it's been so far -- promises. 250 applications to the FDA this year alone for stem cell/gene therapy, expected to quadruple to 1000 by 2021, the field is booming. However, keep in mind that small biotech companies tend to overpromise and underdeliver early on to attract angel investors and corporate partnership, as funding is a serious issue in the R&D phase. Also, there's no reason to think that having surgery would preclude you from Replicel treatment if/when it becomes available to the general public. Commentary on their early trial: "In fact, it could be said that the findings are perhaps underwhelming even for a small scale trial, with the seven “top-tier” respondents to treatment recording a greater than 10 per cent increase in hair density at six months. At 24 months, the average hair density increase for these same patients was 8.3 per cent over baseline. The largest increase over 24 months in a single patient was 21 per cent." I'll believe it when I can run a comb through it.

Man, this thread got so hijacked it might as well have flown into the World Trade Center. Let's try to stay on topic.

To be fair, I think Feller's comments reflect his own experience with FUE. Other docs that have had better results (the Europeans in particular) seem to have found a way to overcome the physical trauma associated with the procedure to a greater degree. Congrats on your upcoming nuptials.

Agree. Might even think of switching to dutasteride. Give surgery a little time.

I wasn't sure about this so I did a quick search through the forums. Lorenzo's higher count patients don't look half bad with buzz cuts. I think we have trained our eyes spending so much time on these forums to look for the tell tale holes of prior FUE. But I don't think there's anyone that misses a strip.

This is a new scanning technique they are using with FUE to predict the direction of grafts using tomography. Crazy!!! Image:

Interesting study about the ratio of hair follicles in the donor area. I highlighted some points in the discussion about FUE transection rates and the new 'turn-key' model of tech run FUE chop shops in Turkey. Interesting that a criticism like this came from Pakistan, which certainly has more lenient regulations as well. The full article is available for free online via Medline.

Well you certainly have an engineer's mind, thank you. Here is the more recent Beehner article which more directly compares FUT/FUE. His overall FUE numbers are not as high as those of the European clinics, but the Europeans that do both procedures don't publish their numbers beyond ballpark estimates on their own websites.

Exactly. Also, I would presume that a bad scar would limit repeat procedures due to the need to keep the scar hidden. Would this be more likely than FUE limitations from scar tissue/density depletion? The cop out answer, and unfortunately probably the most accurate one, is that it depends on the patient. I tend to scar well so I don't think I would have FUT issues. But I also suspect that I won't be on Avodart for the rest of my life. It would be nice to have the comfort that when I put the pills away and my genetic baldness comes through, I'll have some flexibility as far as buzzing it down. The question is, where will the hairline drawn in the sand be at that point? Presumably would be better with strip, but how much better? Enough to avoid shaving? And I'm back at the cop out answer. Good grief.

Blake has stated this in the past, and Diep also said something similar. Other docs that favor FUE seem to focus on yield, hard to get a concrete answer from them about repeat procedures. Having the ability to do one fewer repeat procedure would obviously matter far more than a 5% difference in yield. I haven't seen much commented about it from other docs. Would like to hear from some of the European folks on this. I will update this thread if I come across more info on the subject, even if its the anecdotal experience of individual surgeons. Just trying to get some sort of consensus on the subject.

Ingrown hair, fungal infection, small abscess, less likely tumor. Not much redness on the picture you showed which is a good sign. Show it to your MD,. Maybe think about an ultrasound to see if there is a fluid collection under the skin that can be cultured and drained.

I've reviewed about 50 patient submitted cases of de Freitas on recuperar and about 30 of Couto, will probably have gone through their entire roster shortly. Couto is definitely more consistent and impressive, though de Freitas is close behind. I don't think his 4-5 year wait list is because of his celebrity soccer players alone, though I'm sure that's helped. One of the threads with Javier Farinos (FARI78) is pretty funny, as most of the users doubt it's him until the doc posts a picture of them together. 4350 FUE procedure with 10/10 results. Couto is the best I've seen, does with FUE what Koni does with strip. Occasionally de Freitas will have a case where you're like 'Wow what went wrong there." For the most part elite level results though, and seems to have become more consistent over the last few years. Similar to Lorenzo, beyond most of the North American guys. I would probably put de Freitas slightly above even Feriduni, Bisanga and Erdogan. They both do beautiful hairline work as well, some of the best I've seen. Perhaps the slight difference has to do with tech variability, not sure. To a greater degree we are ranking their support staff in Europe -- I wished they published more information about specific techs, owing to their greater involvement in extraction and placement. Would be nice to have excellence at that level acknowledged as well. That's why it's so helpful when patients include information about the entire staff when they submit their own cases. Both C & F tend to use higher graft numbers and the donor wounds seem larger then those of Lorenzo or Koni, though I'm not sure of the exact caliber. de Freitas quoted me 2.8 k as compared to 2 K most other places I've asked. Not sure if they count the grafts on extraction or implantation.

This is a statement I have heard from surgeons due to the diffuse scar tissue that occurs after the procedure. This would obviously reduce lifetime yield, but I wanted to hear from people who've actually had the surgery. Also, is there any data behind this?