JoeTillman

True, Blake, and well done:)

The severity and nastiness of the debates of the old days makes the debates today seem like gentlemanly discussions at the polo club:)

The forums today are far more tame and politically correct compared to several years ago.

It depends on how much hair is needed to get the job done. For smaller jobs, a few hundred or so, FUE is better for the obvious reasons. For larger jobs of 1500 to 2000 (which is larger for females) FUT is potentially the better technique with a handful of clinics. Why? Because most women have only a patch of strong hair at the back. The sides usually have diffused loss just as bad as the problem areas on the top so any hair taken from the sides is not expected to last very long, or rather, there is no way to tell which hairs will last and which will not. Also, to prevent obvious thinning of the donor zone FUE has to be spread out to distribute the reduction in density and this is very difficult if the healthy donor hair is isolated at the very back only.

Follow your clinic's post-op directions and ignore everything else you read. You didn't hurt anything but stick to the guidelines they give you. The redness was caused by the Rogaine because it was either irritating your scalp or it was just the increased blood flow caused by minoxidil. Some clinics recommend it two weeks post-surgery, some say it's useless but again, stick to your own clinic's guidelines.

He's been back in Madrid for a few months. Contact him through his website... Injerto Capilar

If ever there was a need for a "like" button, this justifies it. The microphone has just been dropped.

Which is exactly why I went with PRK instead of LASIK:)

Follicular BSOD.

The ARTAS costs 200K, potentially more in different countries due to import/export fees and there is a fee for each graft extraction "attempt" so if the graft is unworthy of placement the clinic is still charged for the attempt, successful or not. This is similar to the pricing structure of large business copier/printer leases as well as many other medical devices found in hospitals. The fear of some clinics is that as more and more clinics step on board with ARTAS and the quality improves the clinics will effectively be locked in to the product and short of dumping the system all together they will be stuck with any price increases that are charged by Restoration Robotics. The software updates to the system are not free either so the clinics have to pay through the nose to have the latest and greatest firmware. RR wants to make money, that is their job and their responsibility to their shareholders, but they want to do it by delivering the best results possible not to mention constant improvement is the only way to survive.

That is where the doctor or operator input comes into play as adjustments are made as needed. I know that they don't just hit a few buttons and walk away to let the robot do it's thing. I'm not the biggest ARTAS expert but I intend to learn more about the details as my gut tells me it is here to stay. Scar5, If you believe this then there is no point in discussing this further. Fans? If you say so. And there we have it. Yes, it looks nicer, but how do you explain the "economics" behind my own donor zone? I've had early 10,000 grafts taken out NOT COUNTING my previous two mini-micro sessions and my donor does not look "motheaten" as it should since you say that there is no difference between the two end results. I did not have more hair in my donor zone as the density was no better than average, at best. And if your speculation is correct it makes no difference since no more than an average of 3.5% of singles are in telogen to begin with and since your speculation assumes that these telogen hairs are not shed but will be with scalp laxity exercises then it does not change the final numbers I was speaking about with Mickey with regards to what may or may not be lost due to transection. This goes back to the interaction with the operator. The system will choose which grafts to score based on the size punch it has been fitted with and according to the parameters set by the operator. In other words, it chooses the graft based on the size punch it is fitted with. It does not choose the punch for the graft. This is changed out manually if the operator wants to switch to smaller or larger grafts. What you said about the abrupt or blunt boundaries of FUE extraction are addressed by the robot in that it is programmed to make the extraction as random as possible to avoid that exact scenario. I see this myself in results and I wish doctors, or technicians, would use better judgement with their extraction patterns. KO, If you can get away with a 3 guard, you're lucky. A 4 guard is probably average from the better clinics and while a 3 guard is common I think it is in the minority. Any shorter than that and you're gambling with bad odds. This also depends on your donor density, assuming the best scar outcome possible, as the higher the density of the hair above and below the scar line the easier it is to hide the scar at shorter and shorter lengths. This is also assuming there was no peripheral permanent shock due to transection.

This is beautiful work. Well done.

If it was diagnosed by your doctor then you should follow his/her guidelines for treatment. However, the scrubbing issue is something overlooked far too often especially by new patients. They think that the recipient area shouldn't be touched much after surgery for fear of harming the new hairs. Non HT patients sometimes think that by being very delicate with their hair they are preventing or slowing their hair loss. Both are incorrect and you HT doctor should have told you to resume normal or even vigorous shampooing of your hair to help keep the scalp healthy and free of buildup. The diet issue is something to look further into and I'm not talking about staying away from sweets and sodas either. I'm talking about processed foods in general, sugars and wheat products. Sometimes we have allergies to these foods and don't know it and it can manifest in ways similar to SD. Just something to think about but work with your derm to find a good shampoo to use, I recommend Tardan, and scrub your scalp, don't baby it.

Romanino, Are you referring to seborrheic dermatitis? Was this diagnosed by a dermatologist or is this an assumption due to dry scalp? SD can cause hair to fall out at an accelerated rate and/or in patches but this hair can come back once you have the SD under control especially if the SD is a reaction to diet or lifestyle. I had this once about four years ago and the amount of hair I was losing scared me to death. I eventually learned about diet and how it affects the body (inflammation) and I've not had any real issues with it since. All the hair I lost has come back completely. This may be the same issue for you so watch your diet (avoid processed sugars, flour etc.), exercise, scrub your scalp when you wash and you will probably see improvements.

Blake, Let me be clear, I'm not saying that ARTAS is cranking out excellent results. My point has to do with it's adoption, it's ability to learn and how committed Restoration Robotics appears to be in improving it. ARTAS is better now than it was a year ago and it was better a year ago than the previous year and it will be better next year than it is today. It is getting better all the time and it will continue to do so. You make an interesting point about other devices. I think Neograft is still growing as well, we just don't hear as much about it because the controversy about it has died down online. The other devices such as the wheel and laser assisted incisions were never big to begin with in my opinion and were merely flashes in the pan. In it's present state? No and let me further qualify my position by saying I would not lay down for an ARTAS procedure today myself if given the opportunity. But again, my point is that it is getting better and it will be put into more inexperienced hands than experienced hands and eventually you will see more names that you've never heard of when you do a Google search for "hair transplant". In fact, that is happening right now. I don't agree with it, I just recognize it.

I agree, Blake. I've spoken to several clinics as well that have reverted back to manual or some sort of motorized punch but my particular point is that the machines, namely the ARTAS, is improving and it isn't going away and will only grow in popularity. ARTAS isn't the only robot either. There will be other offerings, and probably cheaper too, as the presence of ARTAS has made other companies aware of the potential so more are getting involved.

I think you are the perfect example of why strip is a good choice for some patients. You obviously thought about the ups and downs of each procedure and you made the choice that you felt was the best one for you. The saving grace of FUE, no donor scar, was not an issue, because you have no interest in shaving. But do not misunderstand today's technology vs. that of the past. Donor wound closure by top clinics is fantastic. I've certainly had my own fair share of them but there is no guarantee of a fine donor scar and the option to hide it completely with SMP and/or FUE is highly subjective. I'm basically responsible for the concept of temporary SMP in North America and I'll be the first to tell you that SMP does not always take well into scar tissue, and in fact, I think that more times than not it just doesn't work well in scar tissue at all but that is a different discussion. Tricophytic closure does not always work either in that sometimes the hair just doesn't grow through the scar tissue and other times, when it does, it does not make a significant cosmetic difference. Point being, even in the best of hands strip doesn't always work out so well in the donor zone and that is why FUE is growing so fast. You went to an exceptional doctor and I'm sure you've had an equally exceptional experience but different patients will have different outcomes even when all of the indicators are a green light across the board.

Scar5, There was no bluff. FUT doesn't thin out the donor the way FUE does. Period. Because it is not so much of an issue for properly performed FUT. For the longest time you and others have talked about how much destruction goes on when a scalpel is used to remove a donor strip but you don't understand the mechanics of how the process works. It makes sense on the outside, but the truth is more involved. When a strip is properly excised the donor zone is first tumesced with saline. This causes the target area of the donor zone to inflate like a balloon and become turgid. It is very firm, almost hard, to the touch. The distance between follicular units is expanded considerably to at least double the normal distance of 1 mm to 1.4 mm. There are already existing patterns for how follicular units are arranged in the donor zone and there are "lines" that can be followed in between the bundles. I talked about this years ago. When the donor zone is tumesced these lines become like four lane highways and the scalpel cutting edge is the equivalent of a fishing line running down the middle of this highway with LOTS of room on either side. A scalpel already has plenty of room in between bundles as the blade is 1/200th of an inch wide which is 1/13th of a millimeter. The cutting edge is far more narrow than this as well. When a scalpel is pushed through the tumesced tissue the tissue separates cleanly and predictably. In fact, when the tissue is tumesced to the right point it then starts to separate at the very beginning of the cut, when the skin is first "nicked" by the blade. It is fascinating to watch and a good analogy would be comparing it to a paper cut. A papercut on your finger is difficult to see because it is so fine and the only thing that tells you it is there is the blood and the pain. Wipe away the blood and the papercut is difficult to see. That same papercut, when the tissue is tumesced underneath it, would be easy to see because it would splay open due to the underlying pressure created by the tumescence, pushing it open. The tissue is fighting to spread open and once the top layers of skin are cut the tissue below just unfolds and this spread from the pressure being released allows for the top of the follicles to be seen along with the length of the follicle. The tissue literally opens up on it's own so THIS is what prevents strip from being a blind technique and allows for an extremely low transection rate. The scalpel is pushed along on the top layer of skin tissue to "score" the path and the tissue opens up behind the scalpel, as it moves along. It is just like the wake of a boat as it travels through the water. The further the scalpel moves along the wider the spread behind it which allows for better visualization of what's going on in the lower layers. With regards to actual graft dissection, it is easy to see hairs that are in telogen if they have not shed. Some clinics utilize back lighting on their dissection boards while others are adept as slivering very fine pieces of donor tissue that are fine enough to be nearly transparent. With FUE these hairs are potentially transected before they are fully extracted so even if the clinic trims their FUE grafts after extraction the damage is still done. This is how it's done in better clinics, or at least some, but other clinics are more gung-ho and may not take so much care as I described but the point is, when done right, the kill rate from a strip removal is in my opinion potentially lower than the kill rate of FUE extraction. Different clinics will have different survival rates with different patients and techniques so of course the above is not anywhere close to being a blanket explanation. Now, what does this academic OCD bickering mean in the end? Absolutely nothing. What matters is the aesthetic result, both in the recipient and the donor, and that the patient went into the procedure fully informed. That is my only concern.

If you are referring to the final result in the recipient zone, then no, it does not produce less density as the extraction method is irrelevant.

Olmert, "At once" meaning in one procedure. I wasn't hedging anything, you're just over analyzing my words:)

I'm cautiously optimistic about it because I recently learned how it, well, learns. The progression of it's efficiency and abilities is fast and it is only getting better each day. I know the company that builds it is working on making it viable for more types of hair types and they are working on smaller punches. My observations tell me that Restoration Robotics really wants it to be more than a sideshow act. This doesn't mean I'm confident in it now, just in how it is evolving. What I do not like about it is that in five years going to a hair transplant clinic will be no more involved than going to the dentist. I say this because there will be little for the patient to review to distinguish between one clinic and the next if they both use the ARTAS and with the fact that it will be performing the placement at some point as well then the specialization of hair restoration will be about as specialized as a computer tech. People will be doing their research on Yelp, lol!

I think we are as well but I think that it is a lower number of hairs discarded because the hairs in telogen (10% to 14%) are distributed through all of the follicular units regardless of the number of hairs in each grouping. For every 100 hairs (some are part of multi-hair FU, some as single hair FU) as many as 14 will be in telogen but because single hair FU's make up no more than about 25% of all FU's on the scalp we have to apply the maximum 14% to that specific subset. As you said, the loss of a single hair to telogen in a multi-hair FU means that the FU will not be discarded. Since it is only the single hair FU's that are discarded due to telogen making them invisible the number drops to 3.5 on average per 100 hairs harvested. This means that for every 1000 grafts we are looking at 35 hairs and for every 4000 grafts we are at 140. I hope this makes sense.

It could, and yes different doctors have various levels of skill to address this but in the end it comes down to how attuned those around you are to how hair is supposed to look. Most people don't get it but if you come across someone that has an eye that is more keen than the average person then they will suspect something is up. It also depends on your own comfort level. Some guys that have surgery aren't the greatest critics. It's a hairline, they're happy, but others are far more hypercritical and even if it looks completely natural they will nitpick it to death to the point that it will ruin their perception of an otherwise awesome result. I think that if you pick a good surgeon then the result will turn out good but if the result will be one that if you look at it and try to pick out the inconsistencies or unnaturalness it will be visible to you. Whether or not you can handle it is a different story.

True. I think option 3 is not so much of an option as misdirected hairs are more easily disguised by longer hair unless you are talking about shaving to a 0 guard. Laser remove won't necessarily add more scars but it will not fill the "divot" scar that may be left behind. FUE will probably be the better option, taken slowly to monitor the healing. 4. Obsolete technologies being used that lead to patchy look (e.g. Plug-style hair transplant). But seriously who is doing this anymore, if you can do FUE or FUT that transplant single graft at a time? Not all FUE or FUT is created equal. Those are extraction techniques and have little impact on the final result with regards to the aesthetics. The size of the "single graft" is determined also by the standards set in place by the clinic. Some clinics will trim the graft to be more "skinny" which means that a smaller incision can be made which then means that higher densities can be achieved and a less pluggy appearance. Also, I've seen many times where a patient has come in for a consultation and they have shown their FUE or FUT result from a clinic where the hairline was full of follicular units but they were multi-hair follicular units. This just doesn't look good much less natural. There are also certain kinds of hair that have a naturally pluggy appearance no matter how finely they are trimmed such as jet black coarse hair on white skin. Cases like this require higher density in one pass with no "transition zone" of low to high density but even then it can be more difficult to avoid a pluggy appearance under close scrutiny due to the nature of the hair. Most cases of folliculitis are temporary and are caused by the growth of new hair follicles after surgery as they try to find new exit routes to freedom. Some of the hairs do not find an exit point so easily and irritate the scalp enough to cause a pimple. I've seen chronic cases of folliculitis, one case in particular that was so bad that he had multiple lumps under his hairline that were hairballs over two years old. The hair kept growing, into a ball trapped under the skin until they had to be surgically removed. This was the surgeon's fault however as the grafts were apparently placed upside down ( I have no idea how this could happen) and the hairs were growing INTO the scalp, not out of the scalp.The doctor would have to seriously screw up and be a complete novice, not to mention an idiot, to screw up so badly. This also depends on surgeon skill and if the recipient area is properly prepped. This comes from experience. The orange peel effect is never fun, neither is pitting or ridging. The orange peel effect is exactly how it sounds, the recipient zone looks like the surface of an orange peel. This is a result of the recipient zone being carpet bombed with a large instrument such as an 18 or 19 gauge needle and is the resulting scar tissue developing into an uneven and mottled surface. Pitting is from the incision being made too deep and the graft being pushed too far down. the area heals into a divot or a sharp dent. Ridging is the opposite and usually occurs around the hairline where the doctor attempted to dense pack. The resulting scar tissue builds up in the frontal permanent and it looks like a ridge. Necrosis is another one to look at and while quite rare is is a game changer. It is usually caused from the surgeon trying to dense pack so much, and with the wrong tool, that it drastically alters the blood flow to a specific area of the scalp which in turn causes the tissue in that area to become necrotic, or dead. It starts out as a serious looking bruise that just gets darker and darker and eventually turns black, gets infected, and over the long term after it heals turns into a hairless zone of scar tissue. It is every hair surgeons' worst nightmare if it happens to them. Permanent loss of sensation is something I think is extremely rare today but it is still possible nonetheless. Bad or no growth. I think this one should be obvious and you should always factor this possibility into your considerations and is where the "find a reputable clinic" issue becomes valid. Reputable clinics have a track record that you can investigate to a degree as opposed to not having any track record for a new clinic. I asked you in another thread where you were considering surgery because you said there is only one clinic in your country but your profile says you are in California. Where is it exactly (country) that you are writing from? I'm happy to help you investigate this new clinic further if you want some help. Send me a pm with the name of the clinic and the doctor as well as the location and I'll see what I can find out. I have many contacts in the industry and have worked in the industry myself for over a decade.

"will be seeing"? Where do you think ARTAS got it's start? ARTAS started out in strip clinics with Dr. Harris and Dr. Wasserbauer being the leads in the FDA trials. Many strip clinics have had the ARTAS for a while now and it is only growing in popularity. It is the more legitimate option to quickly and easily get into FUE and it is currently being heavily marketed to clinics outside of the established hair restoration field. Soon (if not already), your local rhinoplasty clinic will offer robotic hair restoration to compliment your new nose.