Swooping

you can theorize about mechanical stress all u want as ppl have done for the last decade referring to FUE. in fact, at one time FUE was thought to only be safe with 2000 grafts or less.

 

top FUE doctors are not experiencing transection these days with better tools and techniques. and wen u carve a huge chunk of flesh from someones scalp wat do u think happens to hundreds of grafts while the knife slices thru them to remove the chuck of flesh?

 

were referring to YIELD here right? are you saying that the top FUE doctors are not seeing excellent yield with FUE?

 

and yes the yield these days with FUE is near 100% with the doctors I have mentioned as well as probably 20 others I didn't.

That's not what this topic is about dude. No it's not theorizing, the mechanical stress will always be higher with FUE even with the tools currently used. The top doctors or technicians who perform FUE are so skilled that they minimize this. But overall the mechanical stress will be higher with FUE. I only said that FUE has more variability in yield (for grafts that are really placed in the recipient), and I do think this, albeit it's perhaps negligible if you put a top practitioner in FUT vs one in FUE.

That's what this topic was not about. It's about doing mega sessions with high time out of body for the grafts. You think all of the tops guy in FUE allow time out of body times of let's say 8 hours in normal saline? I bet you they don't. Therefore it's important to people to know that they have a good protocol in this.

As you see more and more people are going to less known cheaper clinics. Therefore it's good to be educated on this subject. For example if you go to a unknown clinic and they want to do a 4000 graft session on your head with 4 people in a 12 hour long session in normal saline you know something isn't right and you shouldn't comply with this. Well you can, but it's not a smart thing to do. You make this a FUE vs FUT debate on one little sentence I wrote and interpret it totally in the wrong way, chill out dude.

So please stay on topic. Hopefully more people still want to comment/give their thoughts on this lol.

don't feel dumb cause uve made a fool out of urself making claims that u cannot back up. ur not educating anyone. ur spreading rumors. Beloved Erdogan lmao... so I guess Frediuni, bisanga, doganay, lorenzo, rahal, feller, umar ALL must get real lucky every time they perform a HT huh? ur clueless dude and again STOP spreading rumors! smh

Spreading rumors? You think the mechanical stress is the same with FUT as with FUE? Where do you think the transection and damage to the follicle is more present? In FUT where you have a 3D overview of the tissue or in FUE where you don't?

BUSA claims I all do this to convince myself of going for a FUT procedure, haha. Maniac. This topic wasn't a FUE vs FUT debate anyway what the hell are you talking about? Secondly I went for a FUE procedure myself recently with Dr. Hakan Doganay, so that kinda explains your insanity. Please stay on topic, and don't make this a FUT vs FUE debate, thanks.

you really don't know wat u are talking about! u keep stating in different posts that FUE doesn't have the same yield as FUT. stop spreading rumors that cannot back up with anything other then ur opinion.

 

again, the survivability rate between FUT and FUE grafts are the same. Erdogan, Frediuni, bisanga, doganay, lorenzo, rahal, feller, umar etc.... ALL have a nearly 100% yield while performing FUE so u can theorize all u want but that FACT remains that either FUE or FUT will provide the same yield these days.

 

unless you think their results don't indicate such? cause in the end THAT is wat matters! the results! NOT theoretical opinions.

 

and plenty of them regularly perform 5000+ grafts. just a few years ago 5000 grafts was considered a MEGA session. now its a common procedure performed over two days and plenty of them perform 6000+ grafts as well.

Watch out we someone who is trapped on his tiny willy, because he thinks i'm pro FUT.

The stress to the grafts is higher with FUE than with FUT, doesn't make sense to think otherwise. Also quite laughable you think they all have close to 100% yield. Get into reality. These guys have multiple platients a day what you see online posted is a fraction. You don't see the lower yield examples. They showcase their best results.

Besides that, this story isn't about your well beloved Erdogan. I know you fantasize about him every day in your bed, we all see that.

This story is to educate people so they are not clueless about several aspects which attribute to a success to a hair transplant. That includes not putting the grafts outside of the body for too long and using good protocols in the form of mediums and storage methods. These top doctors generally are spot on with this. Others may not.

While I generally agree with you that one must limit the OOBT. For many of these megasessions, I don't think the grafts are out of the body that much longer than the smaller 1.5k graft sessions we see. Why? Say you have a team of two techs extracting with motorized punch, they can extract far more grafts than a single person/tech using a manual punch (Feriduni, Bisanga, Lorenzo, Erdogan etc.). So the OOBT may not necessarily be greater with a 5k megasession IMO.

Yes you bring up a very good point. Mega sessions doesn't have to mean that the grafts are for a long time outside of the body. A team can also decide to extract for example, say 1000 hair follicles and implant them and subsequently extract 1000 again and implant them and do another 1000 the same way.

BTW I want to add to this, that you can be damn sure the top practitioners generally are using good storage methods and mediums (protocols). That is an important aspect too. I don't think these guys are using ordinary normal saline. Putting your grafts 8 hours in normal saline or 8 hours in Hypothermosol with ATP for example , can definitely make a difference too in the eventual yield. Hypothermosol is btw like 50x more expensive than normal saline too.

Introduction

I posted this in a topic where a guy underwent a huge FUE sessions and his grafts were literally bathing for more than 8 hours outside of the body. You see them time from time, mega FUE sessions where the grafts are for a long time outside of the body.

Many people are not aware of how of an important aspect this is in terms to aiming for the most optimal yield of your grafts.

Therefore I think it's a good idea it deserves it own topic. It's really not even a discussion point if it's important to minimize the time outside of the body. It is. The discussion point would be what time is "acceptable". However know that the longer your grafts are outside of your body the more chance you have of potentially compromising your yield. Good storage solutions and methods, are also important. Know that it's always better to play safe than not to play safe. Don't go for insane sessions. Be educated about this aspect.

Arguments to be made for why it is important

In a hair transplant as you may know the graft is exposed to many stress. A few of those are mechanical trauma, dehydration, hypoxia, ATP depletion, cold injury etc. To opt for the highest yield possible you need to keep these stress moments as low as possible.

During a hair transplant when you extract the graft your hair follicle is separated from the blood supply and develops ischaemia (cut off blood supply). This in itself can already can create cell damage in the form of aponecrosis (cell death), due to free radicals and reactive oxygen species. Therefore it's handy to opt for good storage solutions where the grafts bath in during the hair transplantation. You can for example chill the grafts to reduce metabolic activity and use a good storage solutions like Hypothermosol. To keep this stress as low as possible.

Ironically your hair follicle itself lies in a very specific hypoxic (low oxygen) gradient in your dermis (skin). Disrupting this environment by extracting the hair follicle in itself causes stress too. It's simple,not even the best storage medium today which is used will mimic the environment of the hair follicle in the skin. I quote for example some studies

We found that the human dermis is well-oxygenated, the epidermis is modestly hypoxic and portions of some sebaceous glands and hair follicles are moderately to severely hypoxic.(1)

Hypoxia is believed to promote an undifferentiated state in several stem and precursor cell populations (Mohyeldin et al., 2010) and our results suggest that the lower stem cell niche of human hair follicles may also be in hypoxic environment. (2).

There are many other studies which go in depth and really show how specfic and complex this dynamic mini-organ of the hair follicle itself is. It really shows that the hair follicle resides in a very specific micro- and macro (dermal) environment. Again you can't replicate this all you can do is use optimal storage mediums and methods and cut or extract the graft the best you can with the lowest trauma possible.

Now with FUE unlike FUT the extraction process just puts way more stress on the grafts and the hair follicle. With FUT you cut out a skin strip and you can literally work with a microscope to cut out a perfect graft with tissue around it. In FUE however you can't do this as good and the variability to damage the hair follicle or graft is just higher than with FUT. This is already true as FUE shows more viarability with yield. It's also already a good reason that FUT can get away with doing more mega sessions on a day too. It cuts out a perfect grafts with good tissue around it, so the hair follicle is way better protected when it is put outside the body.

Therefore with FUE because you compromise on the extraction process overall, you need to keep other stress factors as low as possible. This definitely includes not doing mega sessions in a day and definitely not insane FUE sessions where your grafts are bathing 8 hours outside of your body or more.

For a concrete study;

Limmer performed an in vivo time out of body study using chilled normal saline with follicular unit grafts. The results were: 2 h, 95%; 4 h, 90%; 6 h, 86%; 8 h, 88%; 24 h, 79%; 48 h, 54%.[45] Limmer related a good ″rule of thumb″, stating that the loss was roughly 1%/hour. Better storage solutions may improve these statistics. (3)

As far as I know these grafts were generally well cut out too with minimal mechanical trauma, although they used less optimal storage mediums as used by most today. I'll dig up the full study later.

It's really the same with organs, in 40 years we didn't really come that far to preserve them way longer even with better protocols. The hair follicle is a organ too, albeit a mini-organ . If you want to delve deeper into research why and how this is so hard in general to organ transplants, I added 2 studies on the bottom (4, 5).

1. Oxygen levels in normal and previously irradiated human skin as ass... - PubMed - NCBI

2. Journal of Investigative Dermatology - Human Hair Follicle Stem/Progenitor Cells Express Hypoxia Markers

3. Limmer R. Micrograft survival.

4. http://www.ncbi.nlm.nih.gov/books/NBK6156/

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088735/

Conclusion

So all in all it's in patients interest to opt for the highest yield possible and that includes minimizing the time outside of the body (for your grafts) with FUE. If you don't do this , that's fine but know you are not aiming for the optimal yield possible.

Swoop,

I read the same study. Not only does it seem limited, but the test group is taking a serious amount of creatine at the time. I wonder if one were to forego the loading phase would creatine be effective and then would dht levels not spike? Unfortunately there isn't money to be made by anyone pursuing such a study so we'll probably never find out. All I know is it hit me pretty hard and that by stopping I have once again stabilized.

Yeah I agree that the study is skewed. The no testosterone increase but only DHT increase is really baffling too for me. Anyway I won't touch it then not really worth exploring if it can damage my hair due to dht increase.

Sucks though.. I used it once for like 3-6 months when I was much younger and really liked it. On that note did you feel any libido increase or strength increase while being on creatine?

Yeah there is a study done on this;

Objective: This study investigated resting concentrations of selected androgens after 3 weeks of creatine supplementation in male rugby players. It was hypothesized that the ratio of dihydrotestosterone (DHT, a biologically more active androgen) to testosterone (T) would change with creatine supplementation.

 

Design: Double-blind placebo-controlled crossover study with a 6-week washout period.

 

Setting: Rugby Institute in South Africa.

 

Participants: College-aged rugby players (n = 20) volunteered for the study, which took place during the competitive season.

 

Interventions: Subjects loaded with creatine (25 g/day creatine with 25 g/day glucose) or placebo (50 g/day glucose) for 7 days followed by 14 days of maintenance (5 g/day creatine with 25 g/day glucose or 30 g/day glucose placebo).

 

Main Outcome Measures: Serum T and DHT were measured and ratio calculated at baseline and after 7 days and 21 days of creatine supplementation (or placebo). Body composition measurements were taken at each time point.

 

Results: After 7 days of creatine loading, or a further 14 days of creatine maintenance dose, serum T levels did not change. However, levels of DHT increased by 56% after 7 days of creatine loading and remained 40% above baseline after 14 days maintenance (P < 0.001). The ratio of DHT:T also increased by 36% after 7 days creatine supplementation and remained elevated by 22% after the maintenance dose (P < 0.01).

Conclusions: Creatine supplementation may, in part, act through an increased rate of conversion of T to DHT. Further investigation is warranted as a result of the high frequency of individuals using creatine supplementation and the long-term safety of alterations in circulating androgen composition.

 

Statement of Clinical Relevance: Although creatine is a widely used ergogenic aid, the mechanisms of action are incompletely understood, particularly in relation to dihydrotestosterone, and therefore the long-term clinical safety cannot be guaranteed.

56% DHT increase, I never understood this though. Serum testosterone didn't change yet DHT did. DHT is made from testosterone. Approximately 5% of total testosterone undergoes 5 alpha reductase to DHT.

As Creatine did not enhance testosterone levels that means that it should have affinity to 5 alpha reductase and act as an agonist of this enzyme? What else logical conclusion could there be bound?

I so hate this, because I actually want to use creatine as it is a pretty nice supplement but am kinda scared. Especially because I heard many people like Gram experience increased shedding and feel that creatine is doing harm to their hair.

Very natural look , nice.

Would be unwise really to go for a 2nd procedure imo. Only a wastage of your donor. Your density is just to hard to work around with, you'll stay at risk of damaging your native hair and possibly your newly transplanted grafts now.

diffuse thinning of hair can be difficult to treat. Attempting to build up hair density while at the same time avoiding trauma to the existing hair makes this a tough case.

Quoted for truth.

Excellent job furthermore!

How's the back looking?

I'll shoot some pics at the 1 month mark in a few days, also of my donor progression!

Any problems in security checks? :rolleyes:

Just had to take my hat off briefly once at a security check for like 1 sec. No problems at all really!

Congrats on your surgery, the work looks great and I wish you the best for the final result.

Thank you sir!

Thanks Dr. Karadeniz. I can see your point about "feeling" the hair shaft.

 

Unfortunately, I was told the first time around that my scalp was a bit tight. The scar stretched (or at least hair didn't grow for .5cm) and I'm sure it's only tighter now. I hope for this to be my final ht as I'm not experiencing hair loss.

 

If transection is a concern for donor extraction, is it also for the recipient incisions?

Transection is always a concern. If you have much hair in the recipient, incisions may also transect or damage hair follicles. However that doesn't mean that you'll hair follicle in situ will always suffer at all. It really depends on how much damage is inflicted and where the damage is inflicted etc.

Question is why do you wan't to take that much?

You'll probably pee it all out as it won't get absorbed.

This is just variability in a hair transplant, this guy tops the scoreboard. First of all he has a high average of hair with 2.42 per graft, secondly above average hair thickness.

Most importantly he has a diffused hair pattern is on finasteride a few months before the operation. It's easier to work around these native hairs without causing transection due to the way they are spread. He definitely kept most of them.The finasteride may also have further helped him, as results may even continue to go further past the 1 year mark. Furthermore the transplanted grafts obviously regulate their dermal macro-environment and will create adipogenesis and vascularization in the area they are transplanted in. There is a high probability that his native hairs got a extra boost of quality because of this in the the form of thickening.

Couple this with a high yield and you have results like these. However don't stare your down on these results, such results as these are exceptional. These are rare examples in which everything is almost as good as it can get.

Guy must be happy though, genetical and environmental lottery ticket, very nice!

In most cases of Dr.Hakan, I see patients staying only for 3 days, Is it ok if we stay for 7day atleast or may be 10, so that all follicle are permanently dug up !

Do the Clinic have any issue regarding stay?

I don't know obviously but I am sure they could arrange that , you would have to ask. 10 days isn't needed though, most are secure in place at 6-7 days. Also the choi pen assures that the grafts are pretty firm in place immediately and harder to dislodge. I had a very loose fisherman hat which the clinic gave me when I traveled back, no problems at all. Aside from looking a bit goofy .

wow 3800 for that small a area ..... think its too Much !!

Small area? Not small at all imo. 1750 in frontal hairline, 1000 in mid left area behind temple, rest in crown.

To OP looks clean & nice work.

Well I wonder if that was communicated to the patient? In other words 'if we implant 2500 grafts you may lost 800 native hairs in the same area?. In other words, any surgeon actually doing transplantation into existing/diffuse/dense areas should use the utmost precision and caution and not leave anything to chance. I'm not saying the Dr. did or didn't do any of the above but again if you are right about shock-loss and transection risks being so high in these types of cases I hope the Dr. did in fact pay extra special attention to this work. To my eye it does not appear so.

You raise a good point. Yes something like that should be communicated and I have definitely seen surgeons bringing up this to patients in a situation like OP. Perhaps wazaaam himself can shed some light on this.

Is that a documented fact (lost 1 existing for 3 implants when implanting into high-density area)?

No, that is just random numbers I pulled off as an example. However the concept is very well possible, I have heard and seen it before. I don't know for 100% though. Perhaps someone can confirm. But as the OP had a high density of thinning native hair implanting grafts into such a high density may cause loss of these already weak hairs. For instance due to the shock they may succumb, but also because of transection made by the incisions. (Or choi pen depending what implantantion method is used)

Was your initial hairline also lowered? Some direct post-op photos would be great.

Although pre-op you had a very high density already of your native hairs, albeit thinning. Transplanting a graft into a high density of already native hairs may actually damage the native hairs permanently. Or weaken them more so you lose them. Therefore your overall yield could be very low in that sense. For example you are implanting 3 grafts in the front, but for every 3 grafts you transplant you lose one hair follicle of your existing native hair. Hope that makes sense.

Insane result well done. H&W are really one of the best if not the best at FUT in my opinion.

Swooping,

 

I'm getting really sick and tired of reading your blatant insults directed at other members of this forum. Every other day I am getting reports from other members who are also sick and tired of your nasty comments. This will be my last and final warning. If I have to warn you again, I will immediately suspend your posting privileges. I am also going to investigate your IP address is because based on a lot of what you say, I have a suspicion that you two may share IP addresses with Graved11ger and others. As I said, this is only a suspicion not an accusation. But others have pointed out this possibility as well. But I will get to the bottom of this.

 

Bill

At other members? I'm only helping members here, the only who i'm throwing stones at is Karadeniz. With all valid reasons. But yeah ultimately your salary is paid by him so no wonder you got to protect him. Sad story. You are getting to the bottom of this? False suspicion on nothing. You begin to slander me in the same way as Karadeniz does? What a hero. Here I'll help you to get to the bottom of this;

View Profile: Swoop - Hair Loss Talk Support Forums

https://www.baldtruthtalk.com/member.php?32167-Swooping

User Profile

I'm a moderator too at stopaga.com too, it's a private forum with around 500 active member a day. Ask Blake, he's a member there. Perhaps you can scroll around in these forums in my post history, you'll see what opinion people have about me. They only have good stuff to say about me cause guess what; I am there for the members. To educate, engage in interesting discussions and provide my straightforward honest opinion. Heck, I am even going to do something big which will be centered around innovation for the AGA sufferers. Your turn now.

Also I'm in mailing with 2 renowned hairloss researchers and I'll be present at the hair congress in November. You can meet me there. Want that proof too? Or wait perhaps you want a scan of my ID?

Seeing how also most members voted against a doctor joining this site it seems like this site isn't here for the members. It's more like a dictatorship based on nepotism. Even one of your most objective and helpful members left because he felt that something wasn't right. Ban me all you want I'll keep providing my opinion about Karadeniz. Ok I'll be less harsh, but I will definitely heavily advise against him if people ask for opinions. Not only on this forum, I'm already doing that across all forums. If you still ban me that's ok Bill, you think I will sleep any less over it? Heck I will probably smile because it will lay down your motives and the foundation of this site.

To remind you; nothing what I did was wrong, I reported Karadeniz immediately when he slandered me. What did you do Bill? Absolutely nothing. If it would be the other way around a member would be banned immediately.

Yeah, there is it Bill. From time to time it's good to hold a mirror to your own face. Again do what you want then, if I can't give my opinion it's clear. Honesty wins in the end anyway.

Was there blood with it? If not you should be okay. However, please understand that all grafts may not be fully secure yet till day 9 (Dr. Rasman & Dr. Bernstein study) I personally would be pretty cautious for at least 10 days to be on the safe side with your grafts. Always a good thing to correspond with your clinic about this. You are probably fine though, don't worry!

Swooping, you need to watch your language here. Who are you to call me a kid? You being a the representative of another clinic and a troll doesn't give you the right to insult a doctor.

 

 

Moderators please...

Swooping, it is not your business to determine the pricing structure of a surgeon.

Charging by graft intervals is actually in the patients favour as it makes sure that the surgeon is not extracting grafts to make money, but is doing the best for the patient after the price is fixed. This is a topic that may be discussed separately, however your intentions of promoting another clinic while trying to insult me are unacceptable.

I'm providing my valid legitimate opinion about you. I have all rights too, freedom of speech on the forum. All my sayings are based on validity furthermore so I'm not talking nonsense. Yes I think you are mediocre and a little kid, you already showed that. Plus I'll even add to this that you are a big hypocrite now.

Yeah, we see how it is in the patient his favor. The original poster was going to have surgery expecting to have 2500 grafts done, yet you give him 500 less. A deal is a deal, but you just left primary school so you got much to learn I guess. Furthermore never did I say I can dictate anyone his pricing, that is your conclusion. I just said that it is unethical what you did to the original poster and I have all reasons too say that.

Cry to the moderators all you want, I'll keep pressing my opinion about you and advise against you.. Not only on this forum but also on other forums. You gave me enough reasons for it now, thanks. Oh, and just "lol" at me being a representative. Adios, amigo!

I would go definitely for Dr. Erkan Demirsoy then. Seen some nice work from him.

Would definitely not go for Karadeniz.

Johnboy71, i think dr karadeniz covers himself in the graft front by stating between 2000 and 3000 is the same price for him that he charges

So do I understand correctly that you agreed on 2500 grafts. Yet he took 2000 grafts but charged you the same?

Secondly, why were you shocked of your hairline? Didn't you agree both on a hairline that was drawn before the procedure?

Btw thanks obviously for presenting your experience.