Zizou88

@Melvin- Adminyou mentioned on a message I sent you directly that "they charge depending on how the grafts are extracted. Sometimes they divide grafts to have more singles, sometimes they combine them. But how grafts come out initially is how they charge" - does this apply to most doctors?

I want to emphasize my first sentence: the review is not about the result or about thinking their assistants are outside hires. I am not judging the result, at least not now. However, I was lucky enough to be able to choose whichever doctor I wanted, and for me, one of the most important factors was knowing which part of the process is done by the doctor and which part by his team. If I had known Dr. Couto only does the hairline, I probably would have chosen Konior.

The online consultation was directly with Dr. Couto, and as mentioned above, this point was very important to me before making the decision. Therefore, this was the first question I asked during the consultation.

@RobertoDeNiro, to explain, they sent me a report saying they utilized 2,503 grafts. I sent them an email saying that was impossible, as Esteban confirmed the number of grafts taken the first day (1,100), and even if he didn't confirm the exact number the second day, we agreed it was going to be less. That's when they explained that the 2,503 were the splits. So I asked them to send me how many grafts were extracted, and that's the information I still don't have.

Is it normal that after 3 weeks I still don't know how many grafts were extracted? @RobertoDeNiro, you also had a procedure with FUExpert. Do you know how many grafts were extracted and how many grafts were implanted (after splits)? Did you paid for the extracted grafts or the implanted ones?

Clarifying a couple of things from the comments:

• Regarding the splitting of grafts 4 to 2, it was just an example. I am uncertain of the exact process or how the splitting took place. Ideally, I would receive a detailed splitting report to gain a better understanding of the procedure.
• As initially mentioned in the post, my concern does not pertain to the results, but rather to the lack of transparency and process. This includes:
  - As of today I still don't know the total number of grafts extracted.
  - The feeling that I am being charged for more than what was actually performed. The initial estimate included work on the temples and crown that it wasn't needed/done. 
  - Me picking the doctor in a large part because he mentioned he was doing all the implants but that not being the case.
• The entire process was communicated in Spanish, so there was no language barrier.
• It is possible that Dr. Couto's process changed upon moving to his new clinic (recently). When responding to my complain regarding the process on the first day, he mentioned that by attending to only one patient a day he wouldn't have this new clinic. I heard that his old clinic was significantly smaller in comparison to the new one.
• He mentioned that Dr. Torres who did the implantation behind the hairline has been working with him for over 4 years and starting as an assistant.

Separately regarding how these weeks have been, everything seems to be healing well. Just one little red dot remaining on the donor. On the recipient area still some numbness (but seems to be getting better). For the implants itself, I don't think I started shedding yet, the hairline seems to be full, behind the hairline there is some spaces and small tinny gaps in certain areas but I imagine is on purpose not to be as full as the hairline. 

Please note that this review is not related to the result of the procedure, as it’s only been 2 weeks, it's too early to judge.

Pre-procedure

Initial Appointment with Dr. Couto
It took place one year after making the appointment. As I am located on the East Coast, the appointment was scheduled for about 4 am my time. The week of the appointment, I contacted FUExpert to ask how the appointment would be conducted: “Should I call, use Google Meet, Zoom, etc.?” They mentioned I just needed to provide my Skype username and they would call me through Skype, which I found odd. On the day of the call, I woke up at 3:30 am and called FUExpert to confirm I would be getting a call, which they confirmed. By 4:10 am, I called back FUExpert, and they said Dr. Couto would call me any time now. By 4:20 am, I had not received a call, so I called back. They told me the Dr. tried Skype, but it didn’t work, and he had already left. They asked me to wait until he returned. I asked them to call my cell phone, give me their Skype username, and I would call them. I was finally able to speak with the Dr. at about 5:30 am.

Two important things happened during the call:

1. During the call, the Dr. reviewed my pictures and estimated about 2,000 grafts for the hairline, temples, and to reinforce a bit behind the hairline. He mentioned that in a worst-case scenario, if it continues to worsen, it might go up to 2,500 grafts. He said we could plan for 2,500 for now and then review it on the day of the procedure.

It's important to know that before my appointment with Dr. Couto, I had consultations with Dr. Konior, Dr. Gho, Dr. Wong, and Dr. Bernstein, and their estimates were between 1,300 to 1,600 grafts (excluding the crown). I was okay with Dr. Couto's estimate of 2,000 grafts (2,500 if things got worse), as we could always revisit it on the day of the procedure.

2. I asked him what parts of the procedure he performs and what parts are done by his team, technicians, or other doctors. This was very important to me, as I wanted to ensure the chosen doctor had maximum supervision. He mentioned there is a technician who does the extraction, and he does the implantation. Based on his results and that he would do everything except the extraction, I chose him for the procedure.

We concluded the appointment with him saying his next availability would be the beginning of April 2024 (a year after the call). He mentioned that his team would reach out with the estimates to confirm the appointment.

After the call, I sent an email to his team, summarizing what was discussed and requesting the estimate. A few days later, I noticed the team still hadn’t sent it. I followed up, and by the time they provided the estimate (about a week after the call), the next available appointment was no longer the beginning of April but mid-May.

During the year between the call and the appointment, I tried PRP (HIGHLY recommend), which significantly helped my situation. While viewing FUExpert results and considering my own condition, I sent an email with updated photos and comparisons to their results, indicating I didn’t think my procedure would require more than 1,500 grafts based on other patients and FUExpert’s results. Still, they said to keep the initial plan and revisit the number of grafts needed on the day of the procedure.

Procedure

I went on the day of the procedure (day 1 of 2). Their new clinic is beautiful, and the staff is nice and amicable.

Before the procedure started, Esteban (the technician performing the extraction) came, and I asked him about the number of grafts. He mentioned, “Let’s extract 1,100 grafts today and then see after the Dr. reviews it.” The extraction went smoothly, and after the extraction, Dr. Couto came and drew the hairline. We agreed there was no need to do the temples or the crown, and we were just going to lower the hairline a bit and reinforce the back of the hairline.

During the implantation, Dr. Couto worked with another technician who seemed to be helping by pulling/pushing the skin while the Dr. did the implantation. After a while, Dr. Couto left to do another procedure and asked Dr. Torres (another doctor) to finalize the implantations with another nurse. I did not like this, as one of my key considerations in choosing a doctor was to know which parts of the procedure would be done by the Dr. and which parts by others. My expectations after the call were that he would do all the implantation. I don't think I would have picked him if I knew he does not do all the implantation.

This concern grew as the sensation during the procedure was completely different when Dr. Couto was doing it compared to Dr. Torres. The difference in sensation wasn’t much about the Dr. but rather the nurse assisting. When Dr. Couto was working, I felt the technician pulling and pushing the skin, which I didn’t feel anymore when Dr. Torres and the new nurse took over. It seemed the nurse assisting Dr. Torres was being trained, as another nurse was instructing her. At some point, the nurse even asked Dr. Torres, “Why is this happening?” which could have been about anything, but it made me very concerned. After the procedure ended on day 1, about 65%-75% of the work was done. I spoke with Dr. Torres, who confirmed, “Tomorrow, we will need fewer grafts as we completed a lot today.”

I asked Dr. Torres if Dr. Couto could review the work done after he left, but Dr. Torres mentioned Dr. Couto was in another procedure and wouldn’t be able to come.

Afterward, I spoke to the nurse and asked about the plan for the next day. Would Dr. Couto be there? Could he review the result? I wanted to understand who was doing what. She mentioned that Dr. Couto does the most sensitive part, which is the hairline, and Dr. Torres does the rest. I told her that I should have known this beforehand.

The next day, Dr. Couto came, heard my concerns, and explained that this is how they work and not to worry, assuring me everything was going well.

Before the extraction began, I asked Esteban if we were going to do less extraction today based on the work done yesterday. He confirmed it would be less than the first day (1,100 grafts), but didn’t specify the exact number, and I didn’t push for it. After the extraction, the rest of the procedure was the same as the first day, but this time Dr. Couto reviewed the final result before I left.

Before leaving, I asked how many grafts were used. They told me the front desk would have that information. I went to the front desk, and they said the person who had the info (Candi) was not there, but she would have it the next day.

Post Procedure

I went the next day for an initial review. After the review, I asked Candi about the graft count, and she said she would send it by email as she didn’t have it with her.

I returned two days later for the initial wash. I asked Dr. Couto, and he mentioned he didn’t have that information/record with him. Before leaving, I asked Candi again, and she still didn’t have it but promised to email it the next day. Two days later, I hadn’t received it and started feeling uneasy about the situation. It’s been a week since the procedure, and I still didn’t know how many grafts were used.

After calling them and asking for the information, they sent me a report stating they used:

• 2,503 grafts
• 5,858 hairs
• 2.34 ratio

I sent an email stating this was impossible. I told them I had a conversation with Estaban, who confirmed the first day's extraction was 1,100 grafts, and both Esteban and Dr. Torres had confirmed it would be less the second day. Additionally, the original estimate of 2,500 grafts included the temples and reinforcing the crown, which we did not do.

Dr. Couto called me and explained that sometimes he had to split grafts. For example, if he extracted one graft with 4 hairs, he might split it into 2 grafts of 2 hairs each and charge for 2 grafts instead of the single graft extracted.

I was shocked as I was never made aware of this, and all other doctors I spoke with confirmed they charged by the graft extracted. Additionally, I see their results of patients with around 2,500 grafts from FUExpert, and their procedures appear much larger than mine.

I asked the Dr. to send me a report detailing how many grafts were extracted. The next day, I sent an email to FUExpert about my conversation with Dr. Couto, requesting the extraction report and the photos they took, as I wanted to share them for comparison.

It's been a week since then, and they still have not replied to my email. To be honest, throughout the procedure and process, there has been a lack of transparency. I do not know if it’s normal not to have this information two weeks after the procedure. The lack of transparency, communication, and comparison with other cases leads me to believe that their billing is not correct.

Would love to hear from people with more knowledge on the industry if this is normal.
*If I get the pictures they took will update the post with it, as they one I have is not great

@Sokrates thanks for this post as is very helpful.
I wanted to check now that it has been over a year if you had any issues with the scarring or if everything went fine and not keloids were developed.

Thank you for sharing. You mentioned in the initial post that you have Keloids in different parts of your body.
I wanted to ask you if the scars are doing fine on the donor area? 

Wanted to do a short post of a short research I did while looking for a doctor to do my FUE procedure. 
I have been only considering FUE because I only need about 1,700 graph and I do not want the linear scar. For me price/location is not an issue. As all of you I just want the best. 
Therefore I reached out to: H&W, Lupanzula, Konior, Bernstein, Lorenzo

All of them were very easy to communicate with, normally within 24 hours. 
I understand technicians will be assisting doctors during the procedure, so I wanted to learn the actual involvement of the doctor vs. the technician. The price of some of these doctors is very high, so I wanted to understand if I am paying a premium for the doctors procedure how much time will the doctor be involved in the procedure itself. 

Out of the three steps - Extract Graft (EG), Make Graft Openings (MGO), Place Graft (PG) this is what I found:

H&W - Doctor (MGO) - Technicians (EG) (PG)
Lorenzo - vague answer "technicians will assist through out entire process, he will do what he thinks is fundamental on each patient"
Bernstein - Doctor (EG, MGO) - Technicians (PG)
Lupanzula - Doctor (EG,MGO) - Technicians (PG)
Konior - Doctor (EG, MGO, PG) 

With the exception of H&W (only one out of hundreds of great reviews) I haven't been able to find a bad review/feedback from any of these doctors, so I understand their process yield great results. However, if you ask me If I would prefer, Dr. Konior or Dr. Lupanzula to extract the grafts vs. a technician in another great clinic, I will prefer the actual doctors. For that simple reason I decided to not move forward with H&W and Lorenzo. For Bernstein, I haven' t found a bad review but in comparison to the other doctors there are very few reviews available. They only due the FUE with ARTAS. There are some bad reviews about ARTAS damaging donor area, or having issues. None of those reviews were patients of Bernstein, but it make me less comfortable. For that reason I am currently only considering Lupanzula and Konior. 

Following my same logic if you ask me who do I prefer to place the graft Konior or Lupanzula technician, I will say Konior. However, I am still indecisive because most of the reviews and results I found for Konior are for FUT while for Lupanzula are for FUE. Overall I know I can't go wrong with any of them. 

I wanted to share this post I think the involvement of the Doctors during the procedure is important factor to understand, at least it was for me. It also gives you a better perspective when it comes to pricing. For example Konior can be twice as expensive as other top doctors, however, it seems he can dedicate more than twice the time so the price becomes relative. He does one procedure a day while other's do multiple, so it makes sense he charges more. 

If you have this information of the involvement of procedure by top doctors, it will be great if you can share here. 

 

Thanks for the responses and help. I understand the good results the clinic has followed the same process. 
I think I might be more comfortable with another top clinic where the doc is more hands on. Recently reached out to Bernstein Medical - they mentioned "All surgical aspects of the procedure are done by Dr. Bernstein or Dr. Shaver. Technicians check grafts, sort them, and place them into the scalp". Personally will be more comfortable with this type of involvement. 

As most people I have been looking for many years for a Dr. I will feel comfortable doing a FUE procedure.
Based on previous reviews I contacted Hasson & Wong clinic to learn more about the procedure and what would be the involvement of Dr. Jerry Wong if I decide to move forward with them. They mentioned, that "FUE technician will harvest the follicular units - Dr Wong will make all incision sites - surgical technicians will implant the follicular units into the slits Dr. Wong has created". 

Does that means that the premium price you pay for one of the most recognized doctors in the industry are mainly for his incisions? Is this the most important part of a FUE procedure?
Is this the same case will all top level doctors? The mainly focus on the incisions and shape and technicians do the harvest + implants?

Thank for the help.