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?

Hi, what surgeon did you go to and what extraction tool did he use?

The step that is most important in terms of doctor input is the incisions. Technicians extracting and implanting is fine. Though results will tend to be better the more work the doc does him-/herself, the marginal difference is small. Do make sure to get in writing the resume and experience of the technicians that will be working on you, especially the one doing the extractions (the lead hand) You really need to trust me on this: do not go to any doctor that uses any form of micromotor FUE! Motorized extraction tools subject the grafts to a lot more damage than manual ones and will drastically reduce your expected yield and I strongly suspect it also impacts the aesthetic quality of the hair that is implanted. Many micromotor users will deny this and they are all either lying or deluded. There is no benefit to the patient in using these tools, it only serves as a way for the doc and his lead hand to make the work less stressful and for more grafts to be extracted in shorter time (meaning more $$$ per procedure). You should only consider doctors that use manual FUE exclusively. This will rule out Yaman on your list. Incisions should be done using custom blades. Ask the clinic what they use. If they do not use custom blades then that rules them out. In general, do not trust doctors that market their use of fancy (especially self-developed) tools. Often, tools are a way for the doc to make money on the side. You don't want to be a test bunny for something that's unfinished. If you are not constrained on time and budget, you want to go to a clinic that does only one procedure a day, and splits larger procedures into multi-day ones. Otherwise, make sure to google recent results (meaning procedures carried out this time of year in 2018) and see whether growth, design et.c. matches your expectations. If there are no recent results to be found, or notably poor ones, then I strongly suggest you do not take the risk, even if the doc has a generous refund policy. You do not want to get stuck with a poor transplant result. These hints should rule out at least some of the docs on your list. Hope this is helpful.

I think it's fair to wait out the 12-month period. There is a chance that things just happen to drag on a bit longer in my case and that the result will improve by a lot over the next months. It would honestly surprise me though. I don't want to be the guy who's at seven months with shit growth going "maybe I'm just a slow grower??", I prefer to be realistic.

4 month, 3 weeks update: not much happening and this looks like it's going to be a disappointing result. The growth is very uneven in the hairline - drawing a line tracing the outermost hairs in the shape of the design, you can see huge blank spaces and areas where there has been zero growth. It's somewhat similar to HLS2015's result though not as bad. A thing to note was that the doctor ordered his staff to go slow on me as he perceived me as anxious to undergo surgery. While I appreciate the sentiment, the small staff that was implanting meant that this increased the length of the operation to twelve hours and significantly increased time out of body for the grafts. I believe this may have contributed to the poor yield of the procedure. At this point it looks like I'm getting around 20-40% growth in total, maybe less. Still processing the decision and the outcome ATM but obviously I'm quite disappointed.

Healing in donor has been very good actually. I had no shock loss and it looks really dense still. Redness in the recipient area has all but subsided. With regards to improvement over the coming months, I don't really have high hopes. Any improvement is likely to be minor, from things like the hair growing longer. Good transplant outcomes on virgin scalp usually have significant growth materializing by month 4. Like a poster said in another thread, you can usually tell which cases are disappointments/knockouts by this time. I haven't seen any knockout cases where a ton of growth suddenly materialized in month 5 or 6. You never know though.

Checking in for a four month update here. I've decided to leave pics to the PMs as a precautionary measure, so send me a message if you want to see the actual results. I have good news and bad news, essentially. Good news is the hairline design looks quite natural. Bad news is growth is currently quite limited and nothing like the results posted by zx_toth and ftbpicks at their respective four month marks. Some of the implanted hairs never stopped growing and have formed a sparse frame for the hairline. In addition, there are a handful of new sprouts that have come out, mainly in the forelock. New growth in the temples is extremely limited, I can count the current stubble hairs on one hand. I don't know exactly how this will turn out, and it is still quite early, relatively speaking. So I'm giving it another two months before making a final verdict. I've been in touch with the clinic about this and they have reassured me that Dr. Rahal stands by his work and I will also say that I trust them to resolve the situation to my satisfaction if things do not improve.

Having researched a bit since my procedure, I seem to be finding some conflicting information about graft survival and growth. If the follicle is transected (meaning sliced off from the bulb) it obviously won't grow at all. As I understand it, you will see this quite early after the procedure: any grafts that are still growing after the procedure were not transected. However, another factor to consider is the surrounding tissue around the graft. One forum post I found stated that the genetic information that makes the hair grow is contained in the surrounding tissue and not in the bulb itself. Is this true? If so, that would explain how certain extraction techniques can have low transection rates and yet still evidence poor growth in the final results, as they offer lower precision and therefore retain less of the surrounding tissue. Hope someone can clear things up for me a bit.

Thanks. I have to stress that this clinic really sets the gold standard for post-operative care and follow-up. They've more or less been in constant touch with me since the operation and seeing how they've dealt with their patients throughout the years there is a consistent theme of honest dealing and fairness. Attached are some higher res pictures in daylight of the recipient area, day 20 post-op. Apologies for the gross factor. The grafts have started to shed but a lot of them still cling on.

Quick update 18 days post-op.

If you look at the Glassdoor page for Restoration Robotics (the makers of ARTAS), there are comments from former programmers there that the code base is messy and that the development leads are gone from the project. Most of the former employees complain about high turnover and bad management. So you are likely looking at a machine running software that was written by programmers who may not have a good handle on the code. Not exactly what I would entrust to handle my finite number of grafts. Moreover, I think the nature of robotics itself puts a limit on how close the machine can get to the performance of a skilled surgeon or technician. No reputable surgeon should use this equipment, IMO. And I think most are moving away from it seeing how dismal the results have been.