JoeTillman

"Dense" I guess is subjective but I strongly disagree with your "most" comment. I do agree with the latter question, "should they actually do it?". In many cases the answer is a resounding "no".

I'm not one to usually call out clinics for their marketing. Ok, sometimes I do but I have to call this as I see it. Ostrich? Meet Sand. Insert head and ignore the market. Among the multiple problems I see with this there are two that stand out. 1. Patients that don't want a linear don't give a damn about it being 1mm to 2mm. It still is a linear scar. 2. Temporarily reducing tension does not affect the final outcome and the assumption is that tension is the only thing that causes stretch back. What kind of pisses me off about this is that linear scars are supposed to be 1mm to 2mm to begin with so why it is that in 2015 we are only now seeing someting that supposedly ensures this? I smell desperation. In fact this reminds me of what a doctor told me. "I think FUE is just a fad and strip will make a come back". This is the type of thinking that sinks clinics and closes their doors or at the very least relegates them to being shadows of their former selves.

Kuro Sumi ink? Rashes. : rash Mike DeVries European Recall due to carcinogenic ingredients. http://tattooroadtrip.com/blog/investigative-report-cancer-causing-tattoo-ink/ As of January last year Kuro Sumi was still banned in the EU due to health concerns. Further, I called Kuro Sumi to see if there was a guarantee about color change. The man that answered said no but then referred to his arm tattoos that have not changed color in the past five years. It wasn't exactly confidence inspiring. Kuro Sumi does have a very exotic website where everything references ancient Japan, Samurai and dragons, which sounds great and the guys that work there doing tattoo work are excellent, but Kuro Sumi is based in Long Island and the ink is made in New York as well. The only connection I see to Japan is the name and the design of the website which doesn't matter anyway. I don't see why Japan has a monopoly on quality to begin with when it comes to tattoo inks because I'm certain "the old ways" wouldn't pass a carcinogenic and mutagenic examination like modern pigments must. Maybe that's why Kuro Sumi didn't pass EU guidelines.

This is an unfortunate assumption because it means you think I'm for sale, which I am not. For some reason you can't grasp the idea that I don't work for Dr. Karadeniz in a patient consulting position. I'm a consultant for his business. I've spoken to many patients that have asked about him but I've also sent patients to my favorite doctor, Dr. Wong and I have a profile page for him on my website, along with a consultation submission form, of which I receive ZERO compensation. I've discussed the prospect of seeing Dr. Rahal with other patients, a few of which are on this forum. I've also sent patients to a doctor in LA I like, as well as Dr. Feriduni, Dr. Doganay, Dr. Bhatti, and Dr. Lorenzo; none of which have given me a single cent. I don't play the "one doctor is best for all" game anymore because it simply is not true. It is self-serving to the doctor, and the consultant that works for him, and is not in the best interest of the patient. Leave me out of your debates as a point of reference, please, because it is a mistaken assumption that my position reinforces your point.

Thanks Ontop, I've had a really nasty head and chest cold since the day after I got home last week, on top of the jetlag, but I'm well enough so that today I've been organizing the video and images I've taken. Edits start tomorrow so I'm going into cocoon mode to get this done. Thanks for the support:)

No, it doesn't last. That is why it is called "temporary".

Baldken2, The only thing that really matters to me is that you have a consistent position on the issue of trico or permanent SMP. You've come to grips with the fact that if a trico patient is happy then that is what matters so I think it's safe to say the mudslinging about trico will end. Regarding your photos, you are certainly entitled to your privacy. It's just that I find that those that crow the loudest about one procedure being better than another, and claim to have had said better procedure, are usually the last ones to show what they're talking about with photos. I mean, it is super easy to watermark images to prevent them from being used or to even take photos with an identifiable background. Regardless, you've said your peace and you stated your reasons so I respect that. My personal opinion of permanent SMP is that I think it's a bad idea because I've seen too many screw ups, too many regrets and too many guys that have to go through multiple laser treatments to remove it, but I'm not going to create multiple threads or chime in on existing threads extolling the merits of trico when someone is talking about permanent SMP and why they're happy with it. Why? Because it is not my place to do so, and because contrary to what you said, I'm not advertising. My mandate is not to bring in clients for trico through third party forums. I'm not starting threads to talk about it and I'm only answering and addressing questions. I have a completely new website to do my talking for me and it is gaining traction fast. I'm leaving the advertising to the clinics that offer trico and I'm only here to answer questions by those that wish to know more and to set the record straight where the information is incorrect. Here is my motto, and you probably will agree with this. Transparency is the only way to operate in this industry if you want to sleep at night and to help others make informed decisions. Coming from over a decade on the surgical side of things I can safely say that honesty and transparency are in short supply and my mission on that side is to find doctors and clinics that agree and understand that by embracing the negatives that only then can they move forward. The idea that even the best of clinics have "only one or two" unhappy patients is absolute baloney and I'm quite tired of this being the standard response to the question of "do you have unhappy patients?". I've found one doctor that agrees with me and I'm in discussions with several more that I think may as well. On the SMP side of things I think the industry is young enough so that, with the right amount of effort, more transparency can help to shape the industry into being something a bit more respectable. As you said, currently the SMP industry is filled with absolute lies and misrepresentation and with my efforts, and those that have a like minded approach, the SMP industry can become a viable option to consider for those wishing to address their hair loss without surgery. I've actually written a set of conduct guidelines for trico clinics to follow that I think covers everything nicely and if they follow these guidelines then I'll be able to say that I've done my part to ensure that informed consent will prevail and THAT is what matters.

Baldken2, This statement invalidates every single point you've brought up against the procedure. Why continue? How is it unethical if the patient is informed? The very nature of the procedure is temporary so where is the lack of ethics? The technique is clear, the patient understands, the patient pays, the clinic performs. Done. Revisit the math. I told you that Beauty Medical's pricing is 1000.00 for a full scalp and the touchups, which about once a year, is half the price. Example: NW6 Year 1 - 1,000.00 NW6 Year 2 - 500.00 NW6 Year 3 - 500.00 NW6 Year 4 - 500.00 NW6 Year 5 - 500.00 NW6 Year 6 - 500.00 NW6 Year 7 - 500.00 NW6 Year 8 - 500.00 NW6 Year 9 - 500.00 NW6 Year 10 - 500.00 Total? 5,500.00 over the course of ten years. Agreed, but people want hair and this is a good option. And I expected as much. That is why I got involved, because I have a chance to help make this industry better by exposing this behavior, which I did on my other website, with proof of the owners of one SMP company listed as "directors" of this "unbiased" website. Essentially, they run this unbiased website you refer to in which competitors are paying them for advertising. It is also my opinion that Mr. Green is a fictional character. What I don't get is that this "piggybacking" (call it what you will) is clear and open. Hair transplant clinics are learning and then offering the procedure. Everyone knows it is temporary and everyone knows what's involved and the pricing, at least for Beauty Medical, is clear. Each clinic is free to charge what they want but the point is, this is about as transparent as it gets. How is this unethical? How is this a bad thing? Now, unless this is simply an assault on your senses in that it makes your provider look bad, then I understand the hostilitiy. It is clearly stated by trico clinics that SMP does not work for all patients and it does not work in all cases. If your provider is as good as you say then this is no threat and they too reveal this truth about SMP in general because it is true for temp and permanent. If this is the case then your hostility has no logical basis. So which is it? I'll remind you of what you said at the top of your last post... What possible argument can you come up with after saying this?

It's all marketing to some degree and while I agree that a solid presentation among their peers is a good idea I am a firm believer that just because something may be billed as "marketing" doesn't mean it isn't true. If it is done correctly, and I know how to do it, then there will be no question as to it's efficacy. For instance, I imagine you never would have gone to Dr. Lorenzo if he didn't have 200(ish) videos online combing through patient's hair and only presented at the conference. The videos were clear, he combed the hair properly to show what's going on, and many times you see the donor area shaved. There's marketing, and there's marketing the truth, which is a big difference. Maybe they will have a presentation at the next meeting. If so, I'll look for it since I'll be there, and I'll report what I see.

I don't see the need to slam Dr. Feller for this. You may not agree with his presentation but it doesn't mean he's wrong. Everything that I've read contrary to his points is superficial, meaning, many are pointing to the results of this doctor or that doctor as if it refutes Dr. Feller's points, but Dr. Feller is not saying that great results can't be had with "traditional" FUE so I think that the mud slinging in unnessary. This, coming from me, the former mouthpiece of the FUSS movement () I recognize FUE for what it is, the preferred method of most patients that have taken the time to research what FUSS and FUE are. I do not believe, I know, that FUE yield, with everything else being equal, is lower than FUSS but I also know that the differences are negligible enough to where it doesn't matter to the patient even if they do accept this truth. Argue with me if you wish, but do so in a different thread. One thing I've always liked about Dr. Feller is that he's inventive. He just likes to build stuff and he likes to get his hands dirty. I respect a man that sees a potential problem, as he sees it, and gets his hands dirty to address the problem. I'm not endorsing this development because I haven't seen it, which I would like to do, but I have seen a similar approach before by Dr. Wong. How? When he removed plugs from patients that had surgery in the 70's and 80's. Plugs are just nasty little things and FUE is not especially well suited for removal because they don't remove all of the scar tissue that usually accompanies plugs. So what Dr. Wong would do is he would "carve" out the plug in a manner that he called "shelling". He would carve the plug out in an angled elipse that would resemble a half football. With a stich, he'd close it up and the result would be a single thin line scar that is almost imperceptible even on bald skin. I saw him "shell" out 100 plugs in a man's crown and the result a year later, in his hairless bald crown, was almost completely invisible. Oh, and those plugs were recycled into 1200 viable follicular units that were transplanted back into his new hairline and they grew very well. That is why I think this may have merit. Forget the name, whether you agree with it or not. Forget the opinion on FUE in general and look at this for what it is. A modification on FUSS? Maybe. A modification on FUE? Debatable. One could even call it the mPlug due to the amount of hair it removes (I'm not clear on this part). It is all meaningless, really because it is simply a modification for overall extraction. With time, we can make a collective assessment as to it's efficacy and this will take the following... 1. Photos with no flash. 2. Shaved scalp results. 3. Video, not just in HD but in high bitrate HD. Dr. Feller knows what I'm talking about. 4. Good lighting, good lighting, good lighting. And then good lighting. I hope this works out because more options, that work, are only good for the patient. One thing I've learned is that there is no one best doctor and by default there is no best procedure or approach. This may reinforce my position, or it may not, but only time will tell. I wish Dr. Feller and the team success with this approach.

Agreed, but I think that the variations should not be called "techniques" per se. They are all FUE as Scar5 says, which is itself the technique. You have the W**d's Technique, CIT, FIT,FUSE,Ugraft, Neograft, ARTAS, etc. etc. They're all FUE. The difference is the punch , whether is is a human hand/hand held motor/ or robot holding said punch and whether or not the rotation of the punch is an oscillation or a continuous rotation. With mFUE it appears to be a rocking motion but it is still removal of individual follicular units one by one. (**EDIT** I can't verify this. "Miniature strips"? Maybe this takes out more than one FU at a time?) That is by definition, FUE. I've stopped referring to strip as FUT because it stands for follicular unit transplant which is by definition all modern hair transplants. Strip to me is FUSS or "follicular unit strip surgery". I've written about this extensively on my website in the terms & definitions section.

This is dependent on the amount of loss that is being addressed and I can only assume the original author of this five point list is referring to to advanced NWs. If the patient is not genetically predispositioned to progress into deep NW terrirtory then the percentage of recoverable density climbs significantly. Regardless, the message is sound, if not a bit short sighted. This is referring to senile alopecia which does not affect all people. One statistic sets the rate of senile alopecia at 1 in 3 over the age of 70. However, if the work is done naturally and the patient is hit with senile alopecia then it will simply look natual as the condition progresses. This like saying that a face lift won't last you till your're ninety. I think this goes without saying that no treatment will last forever int his regard, for everyone, because then it would no longer be a treatment. It would be a cure. In my case with about 10,000 grafts, my hair may miniaturize with age, but I'll still have far more hair than had I not have surgery and I'm finding that as I get older I have more hair than my friends do when compared to ten years ago when I had little and they had a lot. See # 2. With regards to the scarring, this may be true for some. There's a bit of conjecture mixed in with this. Merck didn't stop because they knew the medication was ineffective past five years. How long does one need to test a medication to see how it works. Five years is a pretty good study and in my experience it does not stop working after five years. It is my opinion that this is a myth propagated by various factors. Yes, and yes, but the differences are negligible for the patient and any minor deficiencies are offset by the lack of a linear scar, which is the whole point of FUE to begin with. In reality, a combination of both techniques will yield the highest number of grafts but few people are in the position to take advantage of both, much less wish to.

Baldken, It's obvious that you are happy with your results and I think that's great. Haircut, too, appears to be happy with his results so why are you taking such an aggressive position toward him? Toward tricopigmentation in general? You've done your research and it has paid off for you so I don't understand the attacks. Would you mind showing us your results? If they are so good I'd like to see them since it only adds information to the collective.

Hi Sean, Yes, you can pm me and I'll give you the relevant info. Dr. Karandeniz and I have no plans on touring but if you can make it to Chicago September 9-13 I can introduce you to him.

Ok, another transparency post. I plan on there being several of these this year:) As of May 26th, 2015, I am the direct B2B representative for Beauty Medical. I won't be online to consult with patients about their SMP options (but I'll help where I can) but rather I'm in charge of finding and recruiting surgical hair restoration clinics for training with TriAC™ Tricopigmentation Academy started by Beauty Medical. This is a fitting result of our ongoing frienship since I first started spreading the word about Beauty Medical three years ago but in the past I wasn't in a position where I could work with them directly. Now that I'm independent I am free to work with whomever I wish just like I'm doing on the surgical side of things as the Hair Transplant Mentor. Why Beauty Medical tricopigmentation? I believe it in. I've seen dozens of cases, I had it myself, and I believe in the ethics of Milena, Giorgio, Stefano and the rest of the crew at Beauty Medical. They truly want to offer, and train clinics in, the best SMP procedure available. This announcement doesn't really have anything to do with patients per se, but as always I want to make it known that I have a professional affiliation, this time, with Beauty Medical.

The fee is €600.00 to €1000.00 depending on the size of the area to be addressed and this includes three passes to ensure refinement and density is to the patient's liking. As far as how long it lasts, I think it is fair to say that a touchup is necessary once a year at half the cost of the intitial investment. Your profile says you have had SMP but you are still searching for a solution. Are you satisfied with your SMP? I read some of your posts where you said you were going to go to a tattoo artist to add density. How did that turn out? Would you mind sharing some photos? I absolutely agree, which is why I think research is so important.

If you had some placement photos after your procedure I'd be able to better address your case but the numbers seem solid with a nice proportion of multi-hair grafts to singles. You should have a stronger density because of this. Dr. Cooley is a really good doctor so I'm sure the result, one grown out, will be great. If you have some post-op photos to share it would be nice to see the distribution.

Hi BaldKen, You are entitled to your opinion, and I respect it, but you should be sure you are forming your opinion based on facts and not marketing. On the flip side, I would never have permanent SMP due to the documented issues that can arise. To date, there is not a single complaint of a tricopigmentation case gone bad. Not enough density? Sure. Not lasting long enough? Of course, but these are not issues of naturalness, just shortcomings of not being enough of one or the other which is easily remedied. The point of tricopigmentation is that one does not have to feel like they made a big mistake that they are stuck with or need to deal with costly, painful and potentially scarring laser treatments to turn around. There are some good results with permanent SMP. I saw one in Milan actually where the dots were really well done with regards to size, but there were two issues. One, the dots were too close together in some areas so the density was inconsistent, which is of course remedied with more work, but the dots were turning green and the work was only a few months old. The solution was either laser or augment with trico. The patient chose the latter which is obviously why I was able to meet him. I want to be clear about my position on SMP in general. I do not believe it is appropriate for everyone and anyone that says otherwise is just looking for money. I'm talking about trico or permanent smp. It doesn't matter because pigment injection doesn't work consistently in donor scar tissue nor does it work consistently in transplant recipient site scarring tissue. SMP of both types works best in healthy skin tissue. The difference is that with tricopigmentation people aren't locked into their decision. If someone opts for permanent SMP then I wish them all the best and I won't question nor criticize their decision because as long as they are informed and are not given false information then they have made a decision that they feel is best for them. My issue is with the information being presented and I want to do what I can to help separate fact from fiction. And to be transparent, I accepted a position with Beauty Medical. This was made official as of May 27th, 2015. I do not work FOR them but I do with with them. The reason I took this position is because I believe in their product and I believe in how they are trying to conduct good business with patient care in mind.

Good points about the number of clinics so I'll revise the statement as Beauty Medical having the largest market penetration as that would indeed be more accurate. I may be wrong, I admit, but this is what I've seen thus far. And to be clear, I don't know what HIS is offering with regards to temporary SMP but I do know what it is not, and that it is tricopigmentation. Tricopigmentation is not just temporary SMP, it is a system that includes the needles, the pigments, the machine and the software that controls it, all working together. The majority of the clinics that have trained with Beauty Medical have done so in the past year and a half, which was my point. This was told to me by Beauty Medical directly yesterday. I wasn't saying that no clinics trained before mid 2013 as several have. Dr. Shapiro trained in November 2012 when Milena traveled to his clinic. Dr. Shapiro was not in New York for her trip in September, 2012 either. You are thinking of Dr. Feller and Dr. Lindsay and there were a few others before then as well. I mentioned Milena's experience because it is relevant to her degree of knowledge, not just with performing trico but also in how to train technicians to use it. Of course no one is going to come out performing trico like she does but they know the core fundamentals to get started and there is a program being put together for continuing education and support. I agree, one company with multiple locations spread throughout various countries would potentially have problems with quality control but I don't see how being under one company name would change this. With regards to the number of cases to view, there are a lot to find on the Italian forums, which I don't think I can link to here. It's easy to find with Google. And yes, Shapiro Medical is very good with trico with their technician Nicole. She used to work with permanent SMP and she says that trico is much better, for the pigments and the tools used to apply them. I just shot a video documenting the work of a trico clinic in Belgium as well which I'll be sharing soon.

Ontop, Sorry, only just now saw this. I flew from Canada since I live in Vancouver. I'm still traveling (I'm in Milan now) and I'll be home later this week. I've started some preliminary editing so I hope to have something ready next week.

Hi Blake, I'll be at the conference in Chicago this year so if you are there we can do just that. I'll introduce you to Dr. Karandeniz and we can talk shop.

Hi Baldken, You said that if temporary SMP had any merit to it then HIS would be performing it. In response to the popularity of tricopigmentation HIS started offering a temporary solution as well so that pretty much answers your question about that. As far as the rate of fading, I've seen it fading on multiple patients when the company I used to work for offered trico. It fades nicely in healthy scalp but as any procedure would be, it is unpredictable in scar tissue. That is why it is absolutely imperative for anyone having any sort of SMP, trico or non-trico, have a test patch done. I'm in Milan at Beauty Medical as I write this and I'll see if I can get some progression photos to share. You mentioned that HIS is the largest provider of SMP. This is not true. HIS has, I believe 19 locations. Beauty Medical, while not actual "Beauty Medical" locations, has their procedure embedded in about 35 hair restoration clinics worldwide so they are in fact the largest provider in the world. They've been performing tricopigmenation for almost ten years and only started to really train clinics a year and a half ago so the growth is very fast compared to any other SMP company. Very few hair transplant clinics offer permanent SMP at all.

Hi Sean, The idea to document like this was to give people an idea of the entire process. The journey as well as the procedure. I think it's important because when we're reading about porcedures performed anywhere, Turkey or not, it is difficult to visualize what is actually involved. Flying from North America is not an easy thing. Flights are long, transition at lay overs a hassle, and I won't even get into the inconvenience of security, but this is all a part of international travel anyway so those that have never travled internationally can finally see what is involved. No one has done this as far as I know so and I hope people learn from it. The pricing is new. It was €1.00 per graft but that wasn't really sustainable because he is only doing one procedure a day. The entire structure is new and is due to our conversations about how to make the cost competitive and palatable. Considering it is a boutique hair transplant clinic in that it is a small clinic and only one procedure is done per day, it makes sense. When larger procedures are performed it is only €1.50 per graft, including everything mentioned. Am I looking for more doctors to document? Absolutey! I really enjoy the travel and I am a hair nerd so I can't get enough of watching live surgeries and now that I get to do this with different clinics I get to report on the differences. I feel that this is a unique opportunity for clinics and patients alike but the documentation I'm doing will only be with clinics that I work with. I'm currently in discussions with a number of clinics now but I'm not going to discuss who they are until I actually get to their clinic and see for myself what they are about. I'm still in Milan so I've not had much time for organizing my videos as I have an extensive amount to sift through but what I have is, I think, really great and I can't wait to get it together.

Harriri, It was great to finally meet you. For those that aren't aware, Harriri has been around a long time and we've had many conversations over the past several years. My trip to Turkey presented an excellent opportunity for both of us. We'd finally get to meet and he'd finally get to have the hairline grafts from his first procedure removed. To be transparent, this procedure was at no cost to Harriri as it allowed his procedure to be filmed by me for part of the documentary on my trip to Turkey and Dr. K's clinic. The offer of strip scar removal only came up after Harriri arrived. A short procedure of less than an hour turned into an all day affair as we all had a lot of discussion aside from the time taken for the surgery(ies). The Turkish market is very interesting and is different from any other HT market in the world and I feel fortunate to have learned about it first hand. The video I shot on my trip won't be edited for a while as I'm still traveling and with over 120gb of video shot so far it will take time to put it all together.

The issue is always different with scar tissue, which wasn't really what is being discussed as far as I know, but that is why it is a part of the Beauty Medical protocol to do a test procedure in scar tissue as has always been discussed openly. If the test is not favorable then a procedure is not performed and it takes a few weeks to see if the test works or not. Harriri, Your donor scar tricopigmentation did in fact fade, quite a bit actually, but not completely. How long it would take to fully fade 100% is not known since scar tissue is so different from healthy skin tissue. Was a test patch actually performed before you had the full procedure?