Swooping

FUE travel to Europe no doubt, that is my opinion at least.

Interesting. I have thought about this actually one year ago;

Why are grafts pulled out that harshly while a simple idea of punching and then doing a horizontal cut below the lowest punch depth with some device could reduce the mechanical stress to some extent on the lower part of the hair follicle (bulb)?

Thank you so much for the reply.

 

I really appreciate it! :-)

 

Any advice on how to increase blood flow to my scalp?

 

Or exercises etc?

 

Thank you

1991time you don't need to increase blood flow to your scalp. It is the biggest fallacy alive in relation to androgenetic alopecia.

What you need is something that can shield you from the stress that is put on your hair follicles by DHT. For instance finasteride which is a 5ar2 inhibitor and thus reduces DHT.

As a hair growth "stimulating" compound you have minoxidil.

Have you looked into these things?

Interesting swoop. Thanks for the reply. Do you believe that for those willing to experiment with the non fda approved/non big 3 that ru is the best place to start/most effective of the bunch?

Yes Gram. RU is a very potent anti-androgen though, it is not be underestimated . The evidence that is out there points to it being more or just as effective than finasteride, but it isn't conclusive evidence.

Anecdotal experience does often show that it is very effective. Enough people who actually dropped finasteride and get on RU and get better results with less side effects for instance.

Kinda shame that RU never got through, let's hope that CB-03-01 will turn out to be very effective and will pull through.

@swoop - my logical mind tells me youre probably correct, but do you know of any studies showing dht reduction when oral are taken in conjunction with topical? Even anything anecdotal would be interesting.

Hey gram, unfortunately not. However I refer to "real" topical anti-androgens not 5ar inhibitors like dutasteride and finasteride. I mean more something like RU58841 which is a androgen receptor antagonist..

It isn't approved though, but many people use it nowadays, even in conjunction with finasteride/dutasteride. Such a combo is practically a preventative cure for everyone. CB-03-01 is also a topical anti-androgen that is running clinical trials currently as you may know. Let's hope it will be released asap!

A combination of a internal 5ar2 inhibitor and a topical anti-androgen is just so strong that it will act as a preventative cure for everybody, no doubt. Well outside the incredibly rare phenotypes that fail to respond to medication in some sort of way.

Anyway I even doubt that many phenotypes will continue to lose hair on solely dutasteride. It would be a very very small subset of people imo.

Finasteride just isn't strong enough for some though;

Don't worry dude. Just normal healing of your skin. My recipient is still red 3 months in currently . Doubt you can even reduce the redness with anything.. The only thing you can do is wait.

Finasteride just isn't strong enough for some phenotypes.

With 100% DHT inhibition AGA can't "exist". It's really that simple.

With no functional or full antagonism of AR AGA can't "exist" too.

Finasteride has like what a mean of 70% DHT inhibition.. This is a average number according to your response to the mediation this may be even lower for some phenotypes

If finasteride doesn't cut it for you then you have the option to go for dutasteride.

A recent study with dutasteride over a 5 year period as far as I recall of about 500+ japanese men showed that dutasteride maintained hair in 99.7% of subjects.

If dutasteride doesn't cut it for you then you may take it one step further and add a topical anti-androgen. You can't possibly suffer from androgenetic alopecia from such a combination unless you are some genetic rarity who doesn't respond well to medication.

We have preventative cures available this moment no doubt for everyone outside of some extremely rare examples.

The question is how far one wants to go.

At that time frame? You don't have to worry. It's highly likely that your yield is already determined at that point. Would be very illogical to think otherwise imo.

No I wouldn't go for a hair transplant if I were you, at least for your mid-crown scalp area.

Why? You are a diffused thinner. Although you are clearly thinning you still have a pretty "ok" density. There are plenty of native hairs left on your head, they are just weak at the moment. If you go insert grafts around this area you have a high chance of losing these native hairs due to direct trauma or indirect through up regulation of factors like HSP.

I see many cases like you who go for a hair transplant and eventually it doesn't turn out to be cosmetically really that much different. Basically you have a high chance of sacrificing your (albeit a bit weak and thin) native hairs for implanted grafts. It's just not the smartest choice in my opinion.

If I were you I would hurry up with the kids and jump asap on finasteride + minoxidil . Minoxidil can do wonders too sometimes, have you considered that?

For your scar, you could fill that up indeed, or you could look into SMP in my opinion. Good luck!

Came across these from another site! I was pretty surprised how well some of these came out

Tricopigmentazione, Micropigmentazione - Risultati trattamenti

Btw I don't know much about SMP whatsoever neither am I affiliated with them in any kind. Thought I would just share!

Came these across on another forum;

Tricopigmentazione, Micropigmentazione - Risultati trattamenti

Seems like pretty damn nice results!

Jup, post a picture and it will be pretty easy to determine!

I read a post recently by a patient who had a HT with Dr. Hakan Doganay: http://www.hairrestorationnetwork.com/eve/179332-dr-hakan-doganay-2800-fue-26-y-o-november-2013-a.html

 

He seemed concerned about the transplant being uneven on one side (That area was transplanted by a Tech). I really don't like the idea of Tech's handling so much of the HT anyway, and I'm actually considering skipping both Docs and finding someone who is more hands down.

 

However, Hakan and his staff seem pretty legit, so you'll likely have a good result down the road. Please keep us posted on your progress.

I understand your concern. I was aware of this. That is why I had requests prior to my operation. One of them was 100% implantation by Doganay. A second one was maximum 1500 grafts a day. They complied to this. Were they not as flexible in this matter I wouldn't go with them. I found these aspects to be important.

Nonetheless if you don't feel comfortable with both, indeed look further. Simple as that. Eventually the decision is yours to make. Be educated so you can make a rational decision.The chance of failure is present even in the most skilled hands of a surgeon though. One can only try to minimize that.

Sure will keep my thread updated. Good luck in your search!

Mechanical trauma is something you want to reduce to aim for a most optimal yield. However that doesn't mean that the graft won't grow or will grow retarded.

Try to relax mate. Just a game of patience now!

why doganay? Happy with choice?

As mentioned here Doganay can work with fewer grafts to obtain a more favourable result. The communication was way better too.

Erdogan rides the "safe" road to cover himself in with often a overestimation usage of grafts imo.

Yes I'm happy with my choice. Can't comment on my results yet though as I'm only 3 months in! Waiting time for me :cool:.

Swoop,

 

Generally, most do smaller extraction tests to make sure patients are even FUE candidates. Most doctors check a number of grafts -- like you described above -- and ensure they are getting okay extraction. It's normally somewhere between 75% to 80% (I think I've heard Dr Vories say he will cancel and recommend strip if he isn't getting at least 80% during the test, and I know Dr Feller does similar analysis). Many check angle and depth requirements during this test as well.

 

Remember, this isn't the only factor affecting yield. Just because a graft isn't obviously transected does not mean it will grow okay.

 

Technically, you could check all the grafts. Many clinics still have the technicians examine and trim the FUE grafts under a microscope. However, usually transection is more obvious and doesn't require this type of analysis.

 

But, I think the first scenario I described is more likely what happened. Dr Vories' comments echoed this. It seemed like there were a large number of grafts scored, but there were issues with delivery. This means you see 3,000 score marks in the skin, but a much smaller number were actually delivered and implanted. This could mean the grafts that were delivered underwent a lot of stress/strain as well.

 

Hopefully this makes sense.

Thanks, appreciate the response. I understand it more clearly now. I assume the neograft can contribute to such problems even more.

@OP sorry for gliding a bit off topic, keep us updated about the situation please.

Thomas,

 

Unfortunately, it doesn't look like 3,000 grafts were implanted. However, it does look like a significant amount of grafts were removed from the donor region?

 

I think a few things may have happened:

 

Ideally, there are two steps to extraction via FUE: scoring of the skin and delivery of the graft. When the skin is scored but the graft is unable to be delivered successfully, the graft is lost to a phenomenon called the failed attempt to successful extraction ratio. I think there is a chance your skin was scored 3,000 times, but there was much less than 3,000 grafts delivered and implanted. This means you may have experienced a high failed attempt to successful extraction ratio, and could explain why it looks like there are many more extraction sites to actual grafts implanted.

 

Another possibility is that 3,000 grafts were scored and delivered, but many were transected and, therefore, implantation wasn't attempted.

 

Unfortunately -- and I'm not trying to bash the procedure -- both these are realities of FUE. Let us know if we can help in any other way. Good luck.

I'm curious now, but how can this be a reality Blake? If I would be a surgeon I would take a sample of 100 or let's say 50 randomized grafts from the donor and analyze those on transection (typically by microscope I guess). From that point one could calculate the average transection rate and decide whether someone is a good candidate.

How would that go in a typical scenario you describe? Someone punches out 3000 grafts and checks them one by one? How, on eyesight? How do they quickly decide which one is viable and which one not? Assuming one would operate in this way it sounds pretty illogical too as it may indeed lead to high graft wastage as Dr. Vories mentioned here. Thank you in advance for explaining.

@OP I would strongly advise you to take a high resolution picture (macro) preferably of both your donor and recipient. From the pictures provided it does definitely look less than 3000 grafts.

I had to make this decision 3 months ago. Eventually I chose for Doganay!

Hey Blake wish you all the best! Up to becoming a world class hair surgeon. I'm sure you'll kick it very far!

So is this called the ugly duckling phase ? I guess so haha. Anyway 1 month pictures. Recipient area still some redness, most hairs are shed. Donor area some shockloss and redness too.

Just for the record Lorenzo because he does all the implantations himself and has multiple cases going has had grafts stored for up to 6 hours in my observation without much concern. I do not know what solution he uses but patients post spray their donor area post op with plain saline.

Thanks good information. 6 hours even in normal saline should be acceptable though. Personally I wouldn't go for higher times than that without better mediums though. But to everyone his own obviously. Do you know what solution & storage method Lorenzo uses? Would be great too know that.

In ISHRS conference at San francisco and Malaysia much was talked about these solutions .ultimately it was concluded newer storage solution will help in improving the bit extra graft survival in a successful HTclinic. But graft drying is considered more dangerous even if you use whatever storage solution .As I said earlier with FUE you have the privilege of transplanting the grafts simultaneously after harvesting.

 

As evidenced based studies are missing and concurrent concepts are not confirmed or falsified. any hair transplant surgeon has the freedom to choose the solution that fits best in his experience and office needs including the financial status of his patients.

Thanks hairsure, interesting. It is a privilege for FUE that should be used indeed by everyone. I really don't see why there should be high out of time body times with FUE (6 hour+ imo), as you can just split sessions basically indeed.

If this privilege is used accordingly then the solution & storage method probably doesn't matter..? Perhaps it does, but it's highly likely that it isn't statistically significant or important in that case. However indeed evidence based studies are missing, so we can only guess!

Good stuff, do you know what Hakan used for storage? I wonder if we can embed these grafts with some of that Aape.

Hypothermosol mixed with PRP. AAPE is interesting indeed, I wonder what impact it can have as a treatment for AGA too.

as already stated the grafts are not outside of the body for very long. in fact, they are outside the body longer with FUT then with FUE. grafts are put in one after another with pre-made slits so their inserted at the same time as the extraction process unlike FUT.

 

FUT grafts will absolutely be outside the body longer so according to ur theory FUE grafts are subject to less trauma then FUT grafts.

 

don't you think the top FUE doctors have already figured out how and where to store grafts wen takn from the scalp and wat solutions they shud be in?

 

you act like FUE is new and FUE surgeons need to read ur thread so they can learn how to properly store FUE grafts so they don't get damaged. this is old news.... this shiit has already been figured out YEARS ago!

 

you seem to have a fundamental misunderstanding of YIELD. yield is determined by skin, hair quality and most importantly surgeon SKILL! during the FUE extraction process the size of the punch needles plays a decisive role. the right type of incisions helps grafts to quickly connect up to blood vessels and nerves making the survival rate increase.

 

being FUE or FUT really doesn't make a difference. a realistic yield from top FUE surgeons these days is over 90% and many times 100%. same for FUT.

 

hair density (30 - 90 FUs per cm) is likely with both techniques as long as the patient is a good candidate. which ever type of extraction method has no real discernible influence on the end result.

 

you keep harping on the bulb and how its thinner. it doesn't mean anything if the right precausions are taken wen handling them and placing them in the proper solution being a physiological solution that corresponds to the human body which is done in EVERY top clinic on the planet.

 

and the fact remains FUE patients these days who get a HT look great! you being a perfect example.

BUSA. Look with FUT because a graft can be cut out with a microscope you can almost always assure the graft gets a perfect cut. This includes the tissue around the hair follicle itself. This tissue is important as it protects the hair follicle itself. Also when you remove a skin strip and you don't start cutting, the hair follicles are still in the skin and the hair follicle is still protected heavily within the dermal environment.

With FUE with a good skilled surgeon often the graft can be extracted exactly the same way as with FUT I agree. A good graft can be just the same way as extracted as with FUT with the same protective tissue around the hair follicle. However the variability is higher in FUE herein. Even in the most skilled hands grafts with FUE will sometimes suffer from transection or damage or a graft which is lacking from the protective tissue around the hair follicle. Simply because with FUE you don't have such a nice 3D view with a microscope to start cutting your way. That's why the mechanical stress and graft quality with FUE has a higher variable.

That doesn't mean that this is a problem. In fact we see from practice that when we compare a top practitioner in FUT vs FUE the yields are probably negligible and the same. Never did I argue that the top FUE surgeons/clinics should be educated on this subject. That's because they know damn well that their protocol should be top notch that includes time out of body & storage solutions (or at least one of these aspects). I really don't see them doing 8+ hour sessions with a bad storage solution & method. For example I wonder what Erdogan his yields would be if he didn't use Hypothermosol mixed with ATP and subsequently wouldn't ask his patients to spray their scalp every 2 hours with ATP. It would matter trust me, maybe not in every patient but I am sure it would affect some in a statistically significant way.

Nonetheless, this was never a FUE vs FUT debacle. I just think that FUT gets a head start in the extraction process if we look at the overall graft quality. Is this a problem when all other things are being cared of? Like skill of the surgeon/technician, good protocols etc. No, not at all!

However I made this topic in response to a guy who underwent a 12+ hour long session of FUE.

Looking at the forum (I just joined), it seems many people are going to less known clinics top FUE practitioners. It's important to be well educated as a potential customer when going to these clinics about this subject in my opinion. That really includes not going for insane out of body times. Storage & method solutions are important too in my opinion. If you go to a less skilled guy who extracts your hair follicles and the overall damage to the grafts is higher than from a top practitioner, these factors become even more important! Trust me. I can give you tons of studies who acknowledge this concept even on a molecular level. It is for these people that this information is especially important & handy. At least I think it is.

This is a very nice result, congratulations.

Yes that's exactly where I'm at. But it is exactly this extra protective tissue that is important for protection of the hair follicle. There is no doubt, that especially the bulb wherein the dermal papilla lies is extremely vulnerable to oxidative stress and mechanical damage/stress (bulge also btw). Having a perfect graft cut out vs a "graft" that is stripped from the encompassing tissue will matter in the time they will survive when they are outside of the body.

If we look for example at this picture we see that the left hair follicle is well cut out while the right one is stripped from connective tissue at the bulb. This exposes the bulb which is very delicate, and this part is extremely vulnerable to oxidative stress. This has been pointed out in many studies by world class researchers. Obviously they can both survive, but the left one will have a way easier time surviving out of the body for a longer time, no doubt. Therefore with the right graft it is even more important to load it back as soon as possible in the recipient. Or to at least use good storage solutions to minimize the oxidative stress outside of the body, or both off course. After all in vitro nothing is going to repair this tissue, in vivo however this is a whole different story.

I just found this review which is much better and goes about the same subject;

http://biolifesolutions.com/biopreservation-media/Bio-Considerations-During-Hair-Transplantation-ajm.pdf

Definitely a good read for everyone, I suggest everyone to read it fully. If you want to aim for the best that includes using the best protocols, these include storage solutions and time out of body times. At least don't fall for ridiculous protocols. Just some food for thought...