Szotz_257

There’s always hope, though you need to keep realistic. You could look into remote work doing programming or web design, for example, which can pay well and spares you the discomfort of having to meet others daily in an office setting. The time you have for yourself can and should be used to cultivate skills or work on projects. Keep looking ahead and keep yourself focused on making tangible progress each and every day towards your goals. Do diligent research on repairs and be patient. What was done to you is a disgrace. It might be prudent to accept that you may never look good again. Your future expectations in terms of social life and women should be modest, if only to spare you the disappointments later on. At the same time, there is a clear possibility, especially given your young age, that you through sheer force of will will be able to get vastly ahead from where you are now. Good luck and keep us posted.

As Melvin suggested, let’s revisit this in a thread of its own.

Hi Melvin. First, not to be pedantic, but there are no factual statements that could technically constitute misinformation in my post. In fact, I make clear that these statements are based on individual perception ("seem"), and my personal opinions ("in my opinion"). Second – while I respect Konior a great deal – a statement by a physician, however well-respected, is not high-quality evidence. For example, you will also find physicians that are still endorsing ARTAS. For conclusive evidence we would need controlled studies, of which none exist, to my knowledge. His statement does not amount to much more than "motorized may be proper to use in certain cases", which I agree with, and is not a wholesale endorsement of the technique as a replacement for manual FUE. I had a lengthy discussion about this in another thread, which I suggest you check out. Long story short, having reviewed hundreds of patient results over the years, I am convinced that motorized FUE will almost always produce worse results in terms of long-term graft survival than manual FUE. Better tools and extractor skill can close the gap somewhat, but not entirely. There are logical reasons for this, more specifically that the grafts are exposed to more heat, force and torque with motorized than with manual. Moreover, the extractor loses the feedback and fine sense of control during extraction. I have no hard data to back this up and therefore need to qualify my statements carefully, but I am working to compile a set of before/afters that could help shed some light on the issue.

Providing such statistics is very hard, as you very well know. All I can do right now is relay soft information imparted through reviewing hundreds of before and afters, tempered by personal experience as I told you over PM. That personal experience also translates to a bias, which I'm aware of and hope I am able to correct for. But longer term, I do intend on compiling a data set of before/afters with manual and motorized to make a systematic comparison. You will be happy to contribute a data point to that, I'm sure. The docs don't need to be unethical or short-sighted to adopt a tool that gives poor results. They may be on the receiving end of sales and marketing efforts, or maybe they are trusting feedback from other doctors which later turns out to be flawed. A few years back, ARTAS was all the rage with many reputable docs investing in machines, which were later left idle as the results were not good. This is all part of the ebb and flow of technological progress in the hair transplant industry, which is still maturing and developing. I will check out the results. Thanks for providing them.

Okay, let's have a look at these. First, based on the comments, both Feriduni and Konior seem until recently to have used motorized on a special, case-by-case basis. Per Feriduni's representative: "The WAW-system with trumpet punch we use especially in cases with curly or frizzy hair". The patient you linked to had two FUE procedures, one with manual and one with WAW. As far as I can tell, the hairline was reconstructed using grafts extracted with manual FUE, whereas the crown work was done with WAW-extracted grafts. Please correct me if I'm wrong here. If Feriduni has made a switch to full motorized, this would be quite recent and there would not be that many patient-posted results on file, if any. Do we have any new hairline results from Feriduni, preferably posted by patients, using only grafts extracted with WAW? As I have written above, I'm not saying that it is impossible to get a decent result with motorized FUE, or that there are no cases where using it is proper, rather that the results will tend to be worse on average, all else being equal. Nothing in your post directly contradicts this. On that same note, do we have any results, whether posted by patients or the clinic themselves, of hairline reconstructions by Konior using motorized FUE? The doctor leads a team, and the desire for convenience and quality-of-life extends to even cases where technicians are doing the extractions. There is no doubt that in the working reality of performing hair transplants every weekday, it is much more comfortable to do extractions using a motorized tool than a manual one. Hence, it is not infeasible that the technicians would be pushing for the use of motorized tools as well. The problems with motorized will not be evident to the team, only to the patient representatives and those who have to live with the final results. The problems become apparent only much later on, months or years after the surgery has been completed. Furthermore, motorized lowers the barriers to entry and the skill floor of a technician. A motorized extraction tool can reduce the time needed to train a replacement, thereby reducing the technician's bargaining power in salary negotiations. As for Devroye, you are correct in pointing out that the case of transplantedphil does not relate directly to the quality of the tool; I even said as much in my post. However, looking at even the results the clinic has posted, where at least some of the extractions have ostensibly been performed by the maker of the tool himself, there is the recurring issue of poor growth. Personally, I would not be comfortable being operated on with a tool from such a clinic.

When did Konior and Feriduni make the switch? I'll try compiling a side-by-side of results. Regarding this tool in particular, I would suggest everyone PM me. Not that this necessarily correlates with the quality of his tool, but I would encourage everyone to read transplantedphil's thread. One feature of Devroye's results that I've noted, even those posted on his website, is low growth, though this cannot necessarily be pinned down to the extraction tool (see my comments below). Though less severe in their effects, the arguments about torque, heat and force do apply here as well. And you still suffer from the lack of feedback compared to manual. I address some of the deeper substance in your comments in my reply to Raphael, below. Good, I will take the last word here, then. In general, the causality chain of a hair transplant result is dense and hard to unwind. As you say, it is unfair to pin everything on the extraction tool to being used. A ton of factors come into play, from tools, patient physiology, management of time out of body, discipline in following post-op instructions, to the skill of the surgeon/technicians during extraction/incision/implanting. Of course, a more advanced extraction tool in the hands of an experienced surgeon will produce better results than a cheap tool in the hands of an inexperienced technician. All I'm arguing is that with all other variables held equal, the rates of graft survival will be lower with a motorized tool, and I have yet to see a convincing argument against that. The aforementioned factors (quality of tool and skill of extractor) will reduce the difference but not close it entirely. Therefore, as a doctor, you are, on average, increasing the risk of a poor result rather than containing it, by using motorized tools. I find it hard to believe, given years of experience using manual punch, that the element of fatigue will be so compromising to the physician or technician's performance that there is a tangible positive delta from using a motorized tool. You may be inferring too much from my post. I'm not calling doctors in general greedy, or purely motivated by money. Every doctor will have a variety of considerations when taking on a patient, based mainly (as far as I can see) on reputation risk, academic interest, personal ethics and financial gain. Usually, all will be present to some extent, but the distribution of these four will vary from doc to doc, and even change throughout a doctor's career. What I'm saying is that using motorized tools makes a lot of sense for the doctor, both financially and in terms of quality of life. Therefore they will be naturally motivated to use them. What may discourage them from using motorized tools is if the motorized tools produce poor results, to the extent that patients complain and post negative reviews online, leading the business to suffer. If the motorized punch produces results that are "good enough" (but not as good as manual), the risk/reward balances out and the doctor can make the switch. Manually punching thousands of grafts every day is really hard, thankless work and I don't begrudge anyone for wanting to reduce stress on their hands and wrists. But as a patient, my instinct is to de-risk, even if I sympathize with the doctor's motivations. When making a choice as a patient, you do not have the luxury to know the outcome ahead of time. All you can do is to make a sober assessment of the various factors that play into the quality of the final result, and (ideally) choose the ones that maximize the possibility of a good outcome. Motorized will never win out here, for simple, logical reasons. I was not calling out Lupanzula, simply pointing out that he is a recent example of a doctor that has made the switch to motorized, and exhorting Fred88 to check out some before/afters to compare the rate of growth. He has produced very good results in the past, though all using manual FUE, and seems like a good guy. Here is a recent thread from someone who had a FUE with Lupanzula where he apparently used motorized.

I think I know which surgeon you are talking about, hehe. And yes, logically there’s no upside to motorized for the patient. All else equal, the graft will have a lower chance of surviving, much lower in some cases. Hair loss is progressive and grafts are finite, meaning graft survival should be one of your highest priorities. This was a bitter and hard-earned lesson for myself personally. No one can make the choice for you and for all I know it might turn out well with Demirsoy anyway. But you at least have my two cents here. Edit: the reasons given for motorized being superior sound pretty weak to me. Of course, expertise and experience are important in order to compensate for fatigue and control things like rotational angle when performing manual FUE. None of this changes the fact that the graft is exposed to more heat, torque and force with motorized than with manual, and that this lowers graft survival. Keep in mind, motorized is very good for docs. They therefore have a powerful motivation to use it, and to convince you that it’s no different from manual, or even superior.

Of course, the skill of the user is a very important in determining transection (I assume this is what you meant) and graft survival in any extraction, whether that is done through motorized or manual. However, given equal skill the graft survival will be lower with motorized, since the graft will be subjected to more damage. At this point I must have compared thousands of before/afters of motorized and manual FUE users, and whether it's the doctor or anyone else using it, the final density is always worse when motorized tools are used. You do not have to trust me on this. Do a systematic before/after comp and judge for yourself. Or even better, find some examples of doctors that have made the switch from manual to motorized and see how things have panned out. Lupanzula being a recent example IIRC. Docs will tell you that there is no difference is skilled hands. But they have a strong motivation to say this, because the tool is a quality of life improvement for them and lets them make more money per procedure. Other than that, I agree with your general point that no patient is alike and that no procedure fits all patients.

Of course, results are what matter. And in my opinion, micromotor on average will always give worse results (measured in graft survival) than using manual punch. This means lower density at the 12-month mark and lower chance of long-term graft survival. Doesn't mean the result cannot be aesthetic despite the lower density. But that's really the wrong way to think of it. As Melvin said in another thread, while money comes and goes, grafts are finite. When they are gone, they are gone. Motorized punch mainly serves to reduce stress for the doctor or lead hand doing the extractions, and for more grafts to be extracted in a shorter time. This lets the doc inflate the graft count and make more $$$. For docs with low per graft quotes it makes total economic sense to use it. But it has zero benefits to the patient.

Yup, exactly as I suspected. Do you know whether they have always been using motorized, or have they used manual punch in the past?

Do a systematic comparison of before/afters and you will see it very quickly. I was honestly quite shocked at how apparent it was. I'm considering doing a separate thread on it. When you think about it it is quite logical why it is the case: Grafts are fragile things. Motorized punch submits them to additional heat and torque, and the doc or the tech doing the extraction loses the fine sense of control during the extractions. Motorized users also seem to have more patients suffering permanent damage or shock loss to the donor.

If he is using motorized now I would strongly suggest you reconsider your choice, or at least think deeply about your decision. The average rates of graft survival between manual and motorized are not comparable. If you do a comparison of docs doing manual FUE and motorized, you will be shocked by how inconsistent and often outright poor the motorized results are.

What surgeon did you go to? The way it bends looks unnatural and may be symptomatic of mishandling during the implanting.

I would like to know this as well. Low graft survival, poor growth and hair falling out later all seem to be persistent problems with users of motorized punch. In my opinion, this (the use of motorized extraction tools) is one of the first things a patient should ask about when consulting, and it should immediately rule a clinic out if they use it.

What tools did they use to extract your grafts? Was it manual or motorized punch?