Dr. Lupanzula Emorane

The short stubble hairs you indicated in the photo were most likely just temporarily suspended. It truly takes a full year to see the results of a hair transplant procedure, sometimes longer. I'm glad that your result filled in with the additional time you gave it.

You can get a hair transplant and while you are young your medical treatment is established. As long as the placement is performed sensibly with a design that takes the future into consideration you should be fine. Your pattern of loss does indicate a NW5A diffused pattern so take that into consideration for your future.

We previously presented this case with a high definition video in this thread. http://www.hairrestorationnetwork.com/eve/188147-dr-lupanzula-2907-fue-2-5-years-later.html Today we have prepared a series of photographs to further show the details of this result. FUE: 2907 Fu's - 33 years old man - NW V - Goals : Frontal hair line + 1/3 frontal area+ temples + plug camouflage

Good day to everyone. Today we wish to present a hair restoration repair case using Medikemos all manual FUE performed personally by Dr. Lupanzula only. This patient presented with diffused NW5A pattern thinning along with previous FUE work having been performed with large punches and the grafts had been placed at a low density. The result was an unnatural aspect which the patient wished to correct. Dr. Lupanzula performed all of the scoring and extraction with his "doctor only" all manual FUE approach. Once the grafts were extracted, the team dissected and refined the grafts using microscopes. All grafts were finally placed into incisions made by Dr. Lupanzula. This result is two and a half years after the procedure. The patient is very happy with this final outcome, as are we.

Your photographic angles make any assessment difficult. However, the situation cannot be addressed without first doing what you can to halt the progression. If you have not begun medical therapy then surgical intervention would be a band-aid solution as you will undoubtedly need more surgery in the future. Our business is FUE hair restoration but we want our patients to enjoy their result for as long as possible without having to resort to frequent touchup sessions because medical intervention is not considered. You're only putting yourself on the merry-go-round. For graft numbers, the estimate can vary. It depends on if the areas you outlined are the only areas to address or if other regions of the frontal hairline should be altered as well. Rarely does it make sense to only address one place in a hairline because oftentimes when you alter one area, another needs to be altered as well to maintain a balance. You should submit a full series of photos for online consultation to get a more comprehensive plan for how to proceed.

We have confirmed all available time slots to meet Dr. Lupanzula in London on October 28th except for one remaining time slot. To secure this remaining time slot please email us at info@medikemos.com. Once we receive your request we will send a reservation confirmation for your time.

I'd like to thank everyone for their support to KO during his development. It is good to have forums such as this for general questions and interaction. I would however like to address some comments and implications being made. There have been some comments about how it is hoped that we will get back to KO and that he has not heard from us. The truth is that we have not even heard from KO regarding his ten month update until today when he sent an email to our patient coordinator with new photos. We have also been in contact during his development and we asked KO to give the result a full twelve months before judgement is passed. Our clinic has been closed for the past several days while we attended the ISHRS annual meeting in Prague. We will be in contact with KO once we return to the clinic this coming week. We wish you all a wonderful Sunday.

Thank you for your comment.

A reminder, Dr. Lupanzula will be in London on October 28th, 2017 for one on one discussions regarding manual only, doctor only, FUE hair restoration. In order to secure your reservation be sure to email info@medikemos.com. Once we receive your email you will be contacted with a reservation confirmation for your visit and personal meeting with Dr. Lupanzula.

We had one patient that spoke highly of American Crew hair fibre.

His last visit to London was booked solid and this next event already has several spots taken due to pre-bookings. Dr. Lupanzula will be back in London on Saturday, October 28th for one on one discussions. Remember, Dr. Lupanzula is one of the only doctors in Europe that performs the entire FUE process himself. This includes the scoring of the graft AND the extraction of the graft, both of which are very critical in the overall process. Email us at info@medikemosclinic.com

**UPDATE** The event for August 12th is now fully booked. If you wish to be placed onto the standby list you are welcome to email us at info@medikemosclinic.com. You can also pre-register for our upcoming October 28th meeting in London.

This patient came to see Dr. Lupanzula to discuss his NW3v pattern of loss and what could be done establish a mature but strong facial framing and to fill the areas of thinning.. Dr. Lupanzula examined the patient and discovered a deviation to the normal NW3v pattern that you can see in the video. Dr. Lupanzula was able to address the areas of concern for the patient and after thirteen months the patient returned for his follow up visit to show Dr. Lupanzula and the team at Medikemos his final result. Needles to say, he is quite happy. Male of 38 years Loss - Frontal hairline, front 1/3 and crown Total FU - 2725 Singles - 456 Doubles - 1564 Triples - 684 Quads - 21

As a reminder, if you are in the London area or plan to travel to London on August 12th, Dr. Lupanzula is offering one on one private consultations. This is your opportunity to have your questions answered about your hair loss and to learn about your hair restoration options from one of the few elite hair restoration surgeons using manual FUE extraction and performing all of the surgical aspects of the procedure himself. Email info@medikemosclinic.com to reserve your time slot.

Dear Bill and David, Thank you both for your kind acknowledgements.

As a reminder, if you are in the London area or plan to travel to London on August 12th, Dr. Lupanzula is offering one on one private consultations. This is your opportunity to have your questions answered about your hair loss and to learn about your hair restoration options from one of the few elite hair restoration surgeons using manual FUE extraction and performing all of the surgical aspects of the procedure himself. Email info@medikemosclinic.com to reserve your time slot.

Today we present another case for your review. This 41 year old Caucasian male presented with NW3A hair loss, salt & pepper hair colour with average hair texture/coarseness. He wished to have his recession addressed and a new hairline constructed to give him a more youthful frame for his face and additional hairstyle options. Dr. Lupanzula personally scored and extracted each of the 3234 follicular units using a CIT sharp manual punch. All grafts were examined and refined using microscopes before they were placed into incisions made by Dr. Lupanzula. The result is documented 11 months after his procedure. The graft totals are as follows: Singles - 695 Doubles - 1817 Triples - 689 Quads - 33 Total - 3234 Follicular Units

Mikeyhwk, Thank you for your kind comments. Palma13, I'd like to take a moment to address some of your comments and concerns. Dr. Lupanzula has been performing hair restoration surgery for over twelve years and has been quite active in Europe as seen in the French and Spanish forums. He may be "new to the scene" in the English language forums but he's been on non-English forums for quite some time now. He has a strong following and a lot of happy patients that have shared their experiences freely. We are going to be working on bringing these testimonials to our new English language website in the coming weeks so you can see what patients have been saying about Dr. Lupanzula for several years. If you have further questions you can continue to email us and we'll be happy to answer your questions as they are presented.

This gentleman came to visit us as Medikemos Hair Restoration in Brussels to inquire about the recession of his frontal hairline and the frontal 1/3 of his scalp and temples. Dr. Lupanzula classified him as a NW3 on the Norwood/Hamilton hairloss scale and determined that he was a good candidate for Dr. Lupanzula's manual FUE protocol. Dr. Lupanzula personally scored and extracted 2618 follicular units using ultra sharp CIT manual punches. His technicians visually inspected and refined these grafts using high powered microscopes as this helps to insure the proper hair counts for each graft. In other words, single hairs for the hairline are confirmed as single hairs for the hairline and multi-hair grafts are confirmed as being appropriate for the areas behind the hairline. The result seen is only eight months post-procedure and more improvements are expected with regards to density and overall fullness.

Dr. Lupanzula will be in London, UK on Saturday August 12th and will be available for one on one consultations. Dr. Lupanzula is gaining a very strong global reputation for excellence in FUE hair restoration, in part, due to his "doctor only" protocols and how the medical ethic guides his approach to patient care. If you are in London or can visit London for this event, you owe it to yourself to take advantage of this complimentary no cost opportunity to have an evaluation by one of the best FUE practitioners in the industry.

Dr. Feller, I have very limited time to discuss these issues as I have 12 hour work days as well as a young family to tend to so I will address what I can with the short window of time at my disposal. Before I do, I would remind you that my name is not “Dr. L”. My name is Dr. Lupanzula. Thank you. I’m surprised to read this because I was not aware of any surgeons performing FUE 17 years ago with regularity except for one and he was not in North America. It wasn’t even introduced into North America until 2002 which was 15 years ago. Who else was performing FUE seventeen years ago? I do not see the connection between hearing these points before and their accuracy with regards to truth today. Logically, the points would be more valid today than they would have been 15 years ago (or 17) as there would be fifteen years of experience to back it up. In my opinion, this is the case with FUE as the early years could not have logically provided the view that we have today as such experience to give valid conclusions simply did not exist. This is not a slight in any way, but is a common sense. Is it not logical to understand something in life better with fifteen years of experience under one’s belt rather than having only six months of experience? Regarding the studies you cite, I would like to address them both along with the contradictions. In the Beehner study it was noted that everyone involved in the procedure had eight years of experience however the total number of procedures having been performed in those eight years was ninety procedures. This is the equivalent of having performed less than nine FUE surgeries each year. Nine. I appreciate the information in this study but the experience level is not the same as one that does the same number of procedures in eight days as opposed to eight years. In addition, as you stated, a manual punch is and later yet this study you reference was using a motorized continuous rotation punch. Furthermore, the author stated With regards to the FOX test, I think it is safe to say that this falls under the “experience” category that I referenced earlier and I disagree that a paper written with experience garnered from various small scale tests applies to an entire industry after fifteen years of discussion and sharing among peers. With all due respect, to believe that nothing has changed in fifteen years is paramount to walking with blinders. And this begs the question; if we have a study that shows something is problematic, do we simply give up, thereby creating a truth that validates the study through inaction and lack of effort to improve? I do not know you, but from your comments, you do not appear to be one that allows studies by third parties dictate how you run your practice. My comment about torsion is not incorrect as you are assuming the follicle to be completely rigid, which it is not. I specifically said that torsion is not an issue if the distance traveled in the oscillation is short. This is why manual oscillation that is controlled from an experienced practitioner is the superior method compared to continuous rotation. There is a difference. The “hand over hand” method you reference does not by definition require significant compression to be applied at all points of contact. In fact, your incorrect assumption is the point of contact itself. I can go into detail but I did not intend for this to turn into a tutorial and these are points that I teach to my students that must spend a minimum of six months in my clinic, many times up to a full year, learning the correct FUE method. Interesting. Comparison of survival of FU grafts trimmed chubby, medium, and skeletonized Beehner-2010 (Their terminology, not my own) In the spirit of sharing research I found this information to be particularly interesting. - Dr. Feller, November 16, 2002 http://www.hairrestorationnetwork.com/eve/145487-another-question-dr-feller.html What has changed since your own research showed a yield that is "higher" than "a dissected strip"? This is largely a rhetorical question. Dr. Feller, I appreciate your passion in this subject and it is this type of vigor that translates well to believing in your craft as you present it to your patients. If you do not believe, you are not genuine and this is against our oath. However, I wish to be clear. I am not here to convince you of anything as it is clear that you are steadfast in your beliefs and I do not believe I am the one to change your mind, nor do I wish to be. I recently heard of you and of your position and comments and felt that some balance should be presented to the issue. Do we have enough raw data for conclusiveness across the field? No, because the field itself is rife with misrepresentation of the highest degree along with a multitude of inconsistencies for an equal multitude of reasons. In this absence we must rely on our own experiences and those of our colleagues that are willing and eager to share, and in turn learn themselves, and this is what I do with my own teachings to my students. I do not conduct weekend seminars and I do not hold video workshops. I take the art of FUE and my oath very seriously, and make no mistake, proper FUE is an art indeed. Physicians that wish to learn from me must reside in Brussels for a minimum of six months if they are already experienced hair restoration physicians, and one year if they are physicians that are not experienced in hair restoration surgery. This procedure is infinitely more difficult to perform compared to strip surgery thus it requires an understanding, dexterity and touch that cannot be achieved with anything short of extreme repetition, practice and passion and these are the forces that are , in my opinion and that of my colleagues, far more powerful than torsion, compression and traction. Good day.

I can appreciate that there are opinions about FUE and FUT that vary and the discussions have been quite passionate. I have performed both procedures for over ten years so I understand both sides of the argument quite well. However, the main argument against FUE here and elsewhere, as presented by Dr. Feller, is that there are three detrimental forces that act on the follicle during an FUE procedure that prevent said follicle from growing as well as a follicle harvested with the FUT technique. These forces are: Torsion Compression Traction Dr. Feller is 100% correct that these forces exist during every FUE procedure, on every follicle. I think that it is only common sense that such forces will exist on a follicle during an FUE procedure. However, I do not agree that these forces cannot be overcome nor should they automatically be expected to lead to a subpar result when compared to an equal size strip surgery. Torsion - This is the reference to how follicular units are subject to the torsional forces of rotation as the punch presses through the skin in order to free the follicular unit from the scalp. I believe that this is a problem mainly with the continuous rotation FUE tools on the market. With an oscillating rotation driven by the thumb and forefinger, torsion is not an issue if the rotational distance traveled is short and performed with an experienced hand. Torsion still exists, but it is greatly reduced in it’s severity thus having an equally reduced degree of trauma. Compression - This is in reference to forceps and how they are used to pull the follicular unit from the scored tissue. As I see it, you either understand how to handle a graft or you do not. Compression is a very real problem and technicians, and even doctors, will routinely squeeze the graft far too hard, and too far down the length of the follicle, to allow for consistent and healthy growth. This occurs not only with extraction but it is a problem with recipient site placement as well, for both FUE and FUT respectively. When I extract each graft after I score, I use reverse traction by holding the top of the graft at the very upper edge of the tissue thereby avoiding most of the follicle. This is safe to do because we all know that the follicle, even slightly below the epidermis can be safely cut through and regrow without permanent damage, as is seen in trichophytic closures in strip surgery that have been performed for the past decade. Traction - This has perhaps the highest chance of causing real damage to the follicular unit but with practice and experience it is not an issue of debilitating circumstance. The bulbs are usually intact as long as the arrector pili muscles have been cleanly severed (best with a very sharp punch) and they come out fairly easily. This is of course not always the case but a proper surgeon will take their time at the beginning of the procedure to properly assess the patient, their grafts, the supporting tissue, and how it all works together. In most cases, the patient is a candidate with very few limiting factors. Skeletonization is one stated side effect of traction but I believe that this is no different than the skelontization that occurs from subdividing follicular units (turning multi-hair grafts into singles and doubles) during strip surgery. It is well known in the community that this is routine procedure for some strip clinics, and the pros and cons of such procedures have been debated before, in forums and in the ISHRS. As with anything in medicine, practice makes perfect. I believe that no man is an island and that when working together with like minded practitioners, the problems we cannot overcome alone, can be overcome together. This is why in my early career I spent a lot of time working with and observing many other doctors to learn their techniques so that I could incorporate the best of their techniques into my own, along with my own modifications of course. I still make sure to attend every ISHRS annual meeting where improvements and ideas are shared and learned, and now the World FUE Institute (WFI) meetings where we are constantly sharing and pushing to improve not only our tools but our techniques in surgical workshop settings. Our next meeting is this month in Athens, Greece. In the end, good FUE is performed by good hands that understand the challenges inherent to FUE but have worked with peers and colleagues to figure out that these challenges cannot be overcome with brute force, but rather a combination of approaches and ideas to coax each follicle out in the safest manner possible. This is an evolution representative of our current time in history, in that practitioners are no longer toiling away in secret, with the blinds pulled down over their windows, to find the perfect solution, but instead are now collaborating with like minded professionals and industry leaders in the interest of advancing the field as a whole. That is why the WFI was formed and it represents the philosophy that I and the other founding members have shared for several years. We share with each other and we learn from each other. In my practice, I very rarely perform strip surgery as it is no longer indicated for the majority of my patients and, quite frankly, no one wants it. The procedure is scary for patients, of course, but no one wants the linear scar, regardless of how fine it may be because they know that this cannot be guaranteed. I score and extract each and every graft myself as I believe it is my responsibility to my patient. My technicians place into recipient sites I create and they examine and refine all of my grafts under microscopes, as it should be, before they are put into a solution of Hypothermosol. I do not take shortcuts and I have taken the time to learn my craft well. For this I believe my results are just as good as any comparable size strip surgery and I believe I have the track record to support this opinion. Again, I understand and agree with Dr. Feller that these three forces he lists do exist, indeed, but I do not agree that these forces automatically spell disaster of any degree for one’s final result. Thank you.

Thank you Mosd and Densedream for your comments. I believe you may not have watched the video to it's conclusion because as a NW3v, the patient also suffered from crown loss, which was also address in this video so the grafts were not isolated to the hairline only. 1003 grafts were placed into the crown, mixed with body hair (see original post for updated details) and 3267 grafts were in the frontal zone. I hope this makes the case more clear.

Hello Everyone, Here we would like to share with you our latest FUE result through HD video. This patient came to see Dr. Lupanzula to correct his NW3v hair loss pattern. Dr. Lupanzula scored and removed 4270 FUE grafts over a two day period. The patient sought the expertise of Dr. Lupanzula due to his "doctor only" approach to FUE and his demonstrated skills in hairline and crown reconstruction. Out of the 4270 grafts transplanted there were 306 beard grafts and 301 chest grafts transplanted into the crown, mixed with scalp hair. The crown total placement was 1003 with 3267 grafts placed into the frontal zone. The result shown is thirteen months after his procedure at Medikemos Hair Restoration in Brussels, Belgium.

If you wish to have more strip then ten months is acceptable but you would do well to wait longer and perform laxity exercises. If you were told by your surgeon that you only need 1000 more grafts laxity may not be an issue especially if your first procedure was the only one you've had so far. Of course, with FUE laxity is not an issue so if that is what you are considering for your second procedure then ten months is fine.