gilgamesh

Wesley's results are B to B+ average. Cooley has some interesting ideas but his surgical technique doesn't match up based on his patient submitted cases. Bloxham is too young. He needs a decade or two more before he can be considered with the elites here. Shapiro - his time has gone. Do more research and keep your geography flexible. The northeast, or east coast in general, are unlikely to be where your answer lies, have been fairly weak for transplant results in this era. Be patient. Better not done at all than not well.

With the prior scar being prominent I don't know if you should risk a third. Perhaps a good FUE along with beard body hair into the strip. I would probably try to revise the scar first because regardless of which procedure you did, less visibility would allow the surgeon more flexibility in picking the harvest site.

Opposite

Is this for FUE or FUT? Or is it the same with both? I would imagine FUT would take longer..

Very helpful, thank you. How often did you have to use saline?

My question is slightly different because I work from home, but I work in a job that requires extremely intense focus for 12 hours straight. I am not as worried about the cosmetic effects, but how long the pain/discomfort after surgery would be to prevent me returning to this level of attention. I know everyone's recovery is different, but is there a ballpark estimate?

It's called recuperarelpelo. Amazing results. He really likes those angular temples wow. Do you have any before pics with hair?

Thanks for your fair handed assessment in the setting of your professional niche.

Ah starting off 2020 with an oldie but a goodie.. the old Scar vs Yield thread Poster 1: I believe FUE is the future and that new clinics are getting the same yields with a less recognizable scar. Coincidentally I have had this exact surgery and I do not believe confirmation bias and cognitive dissonance are at play here. It's just a coincidence. Poster 2: Well that's not what Dr. So and So said. FUT will always have better yield than FUE because 1) yields within a single surgery are better and 2) it lets you have a greater number of total procedures. Also I have had FUT and I do not believe this is impacting my decision to support FUTs. Poster 1: Dr. So and So sucks he isn't as good as Dr. This and That. Based on my review of online cases and my n of 1 experience, I feel confident in letting you know that you're living in the past. Poster 2: Dr. This and That lives in <x> country where there is no rule of law, I don't trust his results. All because a procedure is new doesn't mean it is better. Poster 1: It's all about money. You're a shill. Poster 2: It's all about money. You're a shill. Poster 1: Troll. Poster 2: Troll. They used to have this argument about open heart surgery vs bypass until the numbers came out in peer reviewed journals. Until then, we continue on the merry-go-round. Also 1978Matt, I'm surprised you're not able to find cases from Couto's patients? How about recuperarelpelo? Just turn auto translate on if you can't understand Spanish. His donor extractions are large, but his yields within a single surgery are solid. Freitas and Lorenzo are strong as well, though possibly a half step below in some instances. There are a few other names there, I think they've figured something out. My hunch is that the numbers will eventually show us that stripping out then FUE has the most robust and greatest lifetime yield, and that the excellent short term results from the FUE files of Couto, Freitas etc will be outweighed by a devastatingly low lifetime yield, but you never know. It could end up being the exact opposite.

You probably had high androgen exposure at some point, possibly in utero, so you had an aggressive progression followed by stasis. Whether or not it will continue to progress is a combination of genetics and lifestyle/medication. Take serial pictures from a consistent angle/lighting to see if it changes over time if you are concerned or are thinking of meds/surgery.

Great observation from the op. It is pretty insane how variable post op instructions can be -- there is not much as far as 'standard of care' in hair transplantation because so little has been formally studied. I mean think about it, who would pay for a study to analyze under microscopy the effects of aloe vera vs no aloe vera, vitamin e vs placebo, etc etc in the setting of hair loss. The best you can do is to look at studies about wound healing. The analysis isn't hard, it's just the current model of research in the west is a business model because that's the way capitalistic medical economies work. Companies pay to investigate therapies that will provide a return on your investment. I will google many different doctors' advice and then combine that with advice from the forums and my own general instincts. Beyond that, there's not much you can do.

For a reasonable response please provide your age, medications, family history, and pictures of your frontal hairline and crown.

What makes you so strongly anti-fin? Have you tried it?

Hello all, it has been a while. I was supposed to get surgery a while back, but I was in a bad car accident and everything got postponed. Now I am looking at the forums again and it seems like I am seeing many of the same names, and even their posting volume is down. Some questions for you fine folk: Is hair restoration surgery becoming less popular? Are there any new surgeon standouts? Have the 'holy trinity' or 'magnificent seven' changed at all? Couto, Freitas, Konior, Cooley, Feriduni, Lorenzo, Gabel etc. Is FUT vs FUE still even debated or have we finally settled on this?

I am really impressed with the international representation on these forums, seems like most of the world is represented. I always noticed clinics from Africa and China were missing. I assumed the former was because a lot of countries there were still developing but China always confused me, as I felt it would be a huge repository of potential surgeons and patients to look at and help develop technique forward. Presumably, the stratification of the surgery in tech labor that distinguishes America : Europe (particularly FUE) would be even more pronounced in China, as they really have seemed to leverage this approach with robotics and manual labor in other industries. The closest thing to a "forum" I could find there was through baidu (which is apparently their Google): Does anyone know of an actual Mandarin forum?

Jesus what a horrifying procedure. I wonder if we will one day look back at what we do now and think, "We used to do that?!" Excellent, excellent work as always Dr. Beehner. Thank you for sharing an unusual and challenging case, you are a credit to the art.

For FUE in Europe, Freitas Couto and Lorenzo stand out. No one in the USA is getting their kind of results. Just a half step behind are the Belgian docs. And bringing up the rear is the good old US of A. Turkey, India, etc. are really just too cowboy for me.

Thank you for the update. Can't wait to see how the larger sessions turn out, especially as compared to strip.

Any of this done with piloscopy?

It's coming soon.

It will once the balance tips too far in one direction or the other, and the economic incentive re-emerges.

Yes, extremely simple. As in, so simple it's laughable. Read my first post. Almost no funding required outside of procedural work and a part time statistician. Think about procedures comparing saline to silicone breast implants as an example to start with. Start with a defined end point. An earlier post of mine on this forum contained some of the rough details. I will elaborate later this week when I have more time.

This, by the way, is an incorrect statement. The study would be easy to setup, similar ones have been done throughout the academic history of medicine on, literally, every procedure that exists in surgery. And every time there has been resistance from those doing the old technique that would not go away until the new procedure was shown, in peer reviewed and blinded studies, to be superior. This is the nature of scientific progress. I have already given a rough outline of the method elsewhere. The issue is not the complexity of the study, it is the lack of incentive.

A good peer reviewed study that showed the two procedures as equivalent would make me schedule my surgery almost immediately. Until then, I am reluctant to waste follicles for reduced scar risk, regardless of what the pictures say. I could, for example, very easily list a series of links to patients with poor outcomes from the the elite physicians of hair loss, and it would make many of the former claims seem absurd. But who cares? That means as much to me as viewing their successes -- nothing. The plural of anecdote is not data. It's just one man's experience cherry picking from their own patient database. The patient submitted cases are the strength of this forum, but in the past even they have been circumspect (clinics pressuring patients with good outcomes to post their photos online, offering them discounts or follow up treatment at a discounted rate if they do so, IP addresses overlapping between clinics and 'patients' etc.) Simple thought experiment: ask yourself this, does your Instagram or FB profile really reflect your life? Does your Twitter account really reflect how witty you are in an average conversation? How about if people were willing to pay you hundres of thousands of dollars based on what you posted online? Would you post a fair sampling of your data? Can somebody even be objective about that? Forget about it. I am all for scientific progress. But too many times throughout human history, capitalism has created pseudoscientific progress in the name of the almighty dollar. Let us be aware of this motivation on both sides any time a discussion like this perks up. When you come across anyone who claims to have too many of the 'right' answers about hair loss, they are either 1) lying to you or 2) lying to themselves. I don't know which is worse, but I do know this: both are disheartening, especially when it comes from those who have sworn to heal for a living. That is not an allegation against any of the posters on this thread, but rather a sincere piece of advice for the surgical hair loss community as a whole. It's time for a change in hair loss. Time for something new. This is an abusive relationship that has gone on too long. The reason the research is not out there is because we, as consumers, have not stood up for ourselves and demanded it. The hair loss industry thinks we're too stupid to even care when a procedure has been scientifically proven before we are willing to try it. Are we? Are you? I know I'm not.

Dr. Feller, I have researched hair loss intensively for the last 15 years or so, with a growing focus on surgical hair restoration as my medical options gradually failed. I even spent some time in the more experimental side of hair loss, but ultimately was left without recourse. When I turned my attention to surgical hair loss, I was stunned by the lack of recent peer reviewed, blinded research comparing the two procedures. Especially considering the massive interest in it in the lay hair loss community. Viewing the proceedings of the ISHRS, it seems to be a common topic of discussion in the medical community as well. It is odd to me that a more recent study comparing the two procedures has not come out. And the only reason I can think is economic (or lack of economic) incentive. The reasons I was dissuaded are not unique, and similar to most members on these forums who are hesitating to take the plunge: - The absence of recent peer reviewed data did not convince me that FUE was at the level of strip in efficacy. When looking at it from a theoretical perspective, understanding the histology of the stem cell, it is essentially impossible for them to be equivalent. You look at most schematic representations of the follicle stem cell and you think, "Well of course we can get most of the stem cell with FUE." But a schematic representation is exactly that -- a schematic representation. If you look at stem cell specific stains on histology, the story is quite different. What everyone is forgetting is its not just about the dermal papilla. There is too much of the stem cell that is not around the follicle. Perhaps a punch that splays (as Dr. Umar does) after it enters the skin, or the subgaleal approach of Wesley may have merit, but I have not seen anything as far as results. And as you correctly point out, there is inevitable more trauma when you pluck out follicles one by one. We can talk about the physics of it at length, but intuitively you would have to be in severe denial to not realize this. And no published clinical data. None since Beehner. Lots of marketing. No data. I have not seen any reasonable response from FUE advocates on this subject beyond "Well whatever, look at this patient with FUE he did well therefore your theory is wrong." Anecdotes don't make evidence. - Lorenzo's name is commonly touted on these forums like a garlic rosary to ward off naysayers that say the two procedures cannot be equivalent, and certainly he has impressive results, but he also has a conservative aesthetic, and frankly, no one has duplicated his work. His fans will say it's because he is so amazing, and his detractors will say it's because he is cherry picking. - For strip, my hesitation was for the same reason that everyone hesitates on strip. Great results but difficult to predict a scar. I have had members of my family who have had strip in the past with nearly imperceptible scar formation, so I would not anticipate a bad result for myself, but even then -- difficult to predict. - The data can be too easily manipulated in the absence of an objective and unbiased third party. Especially for the lay public when all we are looking at is some low resolution JPG or shaky handheld video on YouTube. For example, you can count follicles differently depending on if you separate doublets and triplets, which may be the reason that some surgeons with 'lower' numbers produce more bang for the buck (ie. more impressive coverage). Dry labs are not science, they are marketing. We don't do this with cancer research, studies on HIV, or even when deciding what the best blood pressure medication. Why are we doing this with hair? It has become the unfortunate tendency of the internet that whenever a dissenting opinion is presented, the chorus of voices comes out stating "troll! troll! troll!". This is equivalent to someone questioning the Bible in colonial America and having the villagers crying "witch! witch! witch!" Let us stop this emotional and reactive way of thinking. It is no way to investigate science or practice medicine. Our ability to analyze thought in a rational manner has been dramatically catalyzed by the internet. In many senses, this forum epitomizes that progress, but we are not there yet. Let us continue forward, instead of looking at well designed webpages and frequency of internet posts as some sort of Litmus test for the legitimacy of a procedure. Let us return to the evidence, away from inductive reasoning, and back to basic science. It is a candle in the dark in this demon haunted world, and really -- it's the only chance we have at truth.