scar5

Oh... boy You are exuberant and congrats. I know the feeling. Let's go through the points you made. (and I am sure you will get great growth. Here is hoping you a) never wanna buzz, b) don't mind about a thin crown c) have no probs with meds, d) are over 35 1) Stupid. You can't feel anything because your nerves have been severed. Do not stretch your neck. Seriously. When and if, in six months, you decide to complain, you lose. 2) OK..so they told you that, did they? Guess it was a simple choice. 'Son, you have great laxity, by geebes, let's do a strip..' 3) I agree 100% 4) Yeah..whatever 5) it doesn't matter what you do after strip. You can amputate your limbs. You have blown it, so to speak. 6) Dogma?. You want dogma? 'Well, buddy, you have great laxity and you want the maximum number of grafts in future...let's do strip"

Nice work there Jasper, While you are in the area, You said that you'll find a fix or organic/iron oxides within the industry. Could I ask you to agree/disagree with these comments? I think that would be really helpful. a) Most SMP inks are in practice, a mixture (or oxides/organics), b) Some SMP places exclusively use one, some use the other c) All places use both, but what is chosen for you could be either or both depending on what the tech decides. d) There is no point asking your SMP provider about ink at a meaningful level because they won't give away the ingredients for commercial tactical or proprietorial reasons.

Hey BaldKen, i was just about to ask you about your views about ink. I don't know jack about ink, but even a cursory glance at tattoo ink on the web reveals that there are two families of it. (and by the way, this has been discussed on this website before - try 2010,11) Family One Organics Family Two Iron Oxides Organic sounds nice and healthy. Oxides sounds like something out of the 'Love Canal' (To all guys under 50, that means toxic) But in reality, iron oxides naturally occur and cause few problems. Organics (think food dyes) are synthetic. Iron Oxides are more stable. Organics are inconsistent. But Iron Oxides may have traces of foreign matter with them, so synthetic versions have been developed. Now then, 1) Which is your SMP? 2) Which responds to laser favotably? 3)Which fades faster?

Exactly! Dr. Feller will not do FUE on a NW5 because 'FUE is for small jobs'. Busa is only joking, and I don't mind, it is an excellent opportunity to deliver the torpedo into the fat and bloated ship called the 'SS American Strip'. Norwood 5s and beyond will be the last fat cow for North American strip as long as they can maintain the fear and doubt about FUE. They are elastic and their reps are 'evolving' so open your wallet accordingly. Dr. Lorenzo was not the first but now, or until recently, he has been the best.

Wow! You are joking right? I guess John Casper is lying to us. You a bad boy John Casper! Who told you Lorenzo is good for small touch up jobs? Dr. Lindsey and Dr. Feller maybe great artisans, but they primarily do strip and FUE is 'for small jobs'. Moreover, it is my impression (and only an impression) that they, in collusion with others, reps, cheerleaders have maintained the erroneous assumption that FUE is only suitable for small work in the minds and words of this community for a very long time. I think we are in no position to judge doctors quite frankly, but sometimes, we are in a position to judge their legal and economic stakes from where and how they operate. In America it is becoming pretty clear. FUE is unfeasible for most doctors, both for economic and legal reasons. It can support a very small number of doctors doing it only because of the terrible legacy of strip. That will gradually change. Overseas it is vague and it is this vague climate that FUE has thrived as a business model. In terms of good outcomes, IMO, no other doctor reflects better on that rise than does Dr. Lorenzo.

Nick, The hardest question. Good SMP practitioners are good at giving you the answer to suit their needs. The only way to touch up is to keep putting more ink on it or/and use laser to erase trouble spots or trim nasty edges. Both of these have the potential to do harm, but apart from the fact that dots spread and that new dots mean you will have an untextured veneer of silver/blue/grey , I think that is the best approach. You could opt for temporary, aiming for good texture and appropriate color, but for all the pain and expense you are rolling down a ramp so fast you've hardly got time to appraise it before it has gone. Just for how many weeks was it right? Mine was "permanent." It is monochrome, no color (meaning it was diluted with lots of carrier I suppose) Three years later and it has faded. How much I can't be sure because I grow my hair. I can see that there are blotches of darkness that were there from the beginning but have faded in proportion to the rest. The color isn't natural on my fair skin. The dots are not visible to the average eye- just a veneer. The design of the hairline is butt ugly but it isn't the fault of the SMP guy, because he had to follow my hairline and that is another story.

OK..you mean 4mm wide, not 4cm wide, obviously. Yep, well, 4mm wide at the worst point is pretty average. It isn't bad at all. But still, you are now in a situation you a) don't wanna be in, b) you didn't expect to be in, c) you were led to believe you wouldn't be in and d) you are now being told by the guy who did it...well, meh..it 'aint too bad. Man oh man. I have been there befroe and been told that story a hundred times. Welcome to the strip club. You are a guaranteed life-long member. First of all. Just grow a pair, get over it and move on. Don't get stuck in the past!! Just kidding. Here's what you can do. Fill the scar with FUE and SMP and hope for the best. Expect several sessions over many years. Expect that further hairloss will compound the situation and will have you grappling for whether you should just open up the scar again for more hair or to cut your losses. Seriously, just fill it with FUE, then consider SMP. If your scar is flat you might get away with it. Also, if you have the time and inclination. Try to warn young guys about strip and its unpredictability. Best of luck.

Yes, we can appreciate the risks of FUE extraction due to a punch going in around the follicle and not following the trajectory of the graft without sufficient tolerance for protective tissue...that has been around since the dawn of FUE. But saying that now, well, it's kinda taking a drive-by. We don't want to conflate this (very real) concern with the object of our question here. Specifically, I am concerned with how fibrotic scarring compromises subsequent FUE procedures. What you have added here, is that the scarring attaches itself to the base of an adjacent follicle, that once successfully cored by the extraction device, is somehow 'stuck' and thereby is difficult to pluck out by (usually a tech) . Well,firstly, if plucking is so difficult, why is this task usually given to the techs in the first place, especially in subsequent FUE procedures which, as you say, are known to be difficult? Wht you do confirm, is that the actual coring task is not compromised by the fibrotic scarring, except that at the very bottom of the plunge, twist, rotation, where somehow, the extraction device cannot penetrate through the firbrotic tissue. I imagine depth control, and sharper device might come into consideration? But anyway, thank you for your comment. I'm far from convinced at this point, that fibrotic scarring is the menace it is presented as, but I am ready to have my mind changed.

BRAVO Hairweave!! I don't know if that is a definite answer, but that is certainly the most profound and plausible! Thank you!! Best Quote! "The reasons for the lag in NA is economic not concern about subcutaneous scar tissue." NA = NORTH AMERICA BLAKE, And all strip docs insisting on compromised FUE procedures due to fibrotic tissue!! Here is your chance to save your skins!! :eek: Don't settle for this. I am being playful but real here:) Tell us why, exactly and how exactly you it happens. Otherwise, we are going to think this is just another phoney card in the ongoing rolling strip defense!

Hairweave, while I was writing the above reply, I missed yours. I'll read and many thanks!

Hair, On re-reading our post, perhaps, obliquely you did subtly flash your little mirror from the Lorenzo corner, in a way the commercial operations have to do it, but boy oh boy, it is very hard to decipher anything tangible out of it. Blake, You won't comment on "how this affects yield" or impedes successful extraction because you don't have data? Well, you have commented and thank you. Well, is it back to square One! OK, let's take stock. Blake shows us that fibrotic scarring forms OUTSIDE the extractions sites, deeper, but won't elaborate on how or why it impacts the situation. Read what you will into that and remember that FUE scarring from a 1mm hole (circa 2000-2008) is not just 20% more than a .8mm one. Hairweave infers that it doesn't bother Dr. Lorenzo and he 'aint about to start doing strip because of it. Little old me asks, if it doesn't bother Mr ARTAS or Mrs. Neograft or their poor cousins 'The Rotary Drill' family , should we jump on the ship with them, or jump ship altogether. This is research folks. This is what we are supposed to do. And look how hard it is. Anyone else wanna have a go?

Oh..Blake, I was writing a reply just as you sent yourI7ll read and consider. Thanks

Hair, I know this thread isn't only about my dear little question but I surely hoped we were gonna get someways towards answering it. So I am gonna mark you hard here, caused I'm getting frustratingly close to getting an answer about something that should effect each and every future HT candidate even remotely considering the FUE route. Damn it Hairweare!!! You completely dodged the issue!! Now we risk running off topic from what I believe is a crucial crossroads decision in our path to real knowledge. 1) You don't wanna "buy in?" OK..whatever. I would have thought you could add something. 2) no...wait up. We are being told that FUE scarring is bad!! bad, bad..not for white dots etc., but because it compromises subsequent FUE procedures. We need to know if this is true. Why? How? Is it BS? How does it impact Artas, Neograft, rotary drill operators? This is the key. Is the scarring limited to the .8mm hole? Does small extraction sites eliminate the problem? It is very plausible that strip clinics use this stuff against FUE basing it on the 1mm days. It is also plausible that FUE operators are full of BS too, cashing in on the dreadful reputation of the strip clinics. We need to sort this out.:confused: 3) This is uninterpretable to me. What do scalpels have to do with it? I guess it is something to do with strip scarring compromising future FUE? 4) So you are saying Acell is just a load of baloney in terms of reducing fibrotic tissue build up in FUE extraction holes. Fair enough - and this IS relevant and ON topic. Actually, one of the biggest and earliest FUE innovators from Atlanta (banned from mention, as is common for early FUE clinics) is of the same opinion last time I checked. Anyone out there got anything to say about whether fibrotic scarring caused by FUE donor extraction makes the prognosis for future FUE operators bleaker?

Thank you again for your reply. Let's see if we can get a little closer to the kernel of the question I am asking you. Why does scarring caused by FUE in the donor (I repeat DONOR!) make for a poorer prognosis in subsequent FUE operations? We are led to believe that extraction is difficult because of the formation of fibrotic tissue in the donor. I say, "Who cares if it is more difficult, we pay, so you do it!" Now you might reply, "Very well, scar5, but your yield will be compromised because pulling the grafts out the area is more difficult than pulling FUE grafts out of virgin donor scalp". I ask, "How so, doesn't the scar tissue form in the extraction sites, and since we are not going to re-visit an extraction site, what difference does it make?" Now what is your reply? Fill this space please....................................................................... You might say (as I mentioned in an earlier post on this very thread) that scar tissue spreads laterally from the extraction sites and this interferes with a doctor's tactile feedback. Furthermore, this lateral scarring distorts the lie of epidermal and dermal layers resulting in the angle of existing growing grafts being unpredictable shifting. To which I would say, "Very well, but now we are living with ARTAS, Neograft and Rotary Drills, and I can't see tactile feedback bothering them too much. So much for difficulty. You could then say, "Well, that is just it, they butcher grafts!" And then I would believe you and say presto, thank you." However, you haven't said. You are just talking about generic stuff. Finally, and I do not mean this to be in anyway critical (we value your or anyone's input) you close by saying stuff like, 'each doctor has his own opinion, it is up to you to do your research and decide for yourself' Which is rather unsatisfying for a person seeking to uncover the facts of the matter, because indeed there is a 'matter' and there are 'facts' about it.

Thank you for replying. Yes, Minox will stretch circulation, which is supposed to be good for hair. (Doesn't it deliver more DHT too? -nevermind:confused:) Congratulations to to Dr. Cooley for implementing Acell as an early innovator. So can you (or anyone) tell me why scarring caused by FUE hampers subsequent FUE operations when they are performed by , a) Artas robot, b) Neograft, c) Rotary or mechanical device - type FUE procedures?

OK! Not a bleeding issue. Right. I get it. Some clinics do believe it IS a bleeding issue but I'll take your word for it! And I didn't read your response properly because you said that Dr. Cooley allows patients to take minox right up to the day of surgery where as elsewhere, patients are encourage to stop it for quite a long period prior to surgery. FUE or strip do not dictate where hair is placed. Yes, of course it has nothing to do with it in a technical sense, but design wise, a lot of strip patients end up growing out for the illusion of density, sweeping their hair back and this sort of style requires frontal density at the expense of crown. FUE guys can go for a lower but global kinda density thing, hoping for a buzz. (easier said than done! beware guys!) That is where I was coming from. IMO, there is an indirect link but perhaps that is for another thread. Donor sites too? OK. So Dr. Cooley puts Acell into FUE donor sites? Nice. I remember asking my doc to do that back in 2009?10? but it was still kinda new so they didn't do it. Still, it doesn't answer my question about why subsequent FUE procedures are difficult on account of previous FUE procedures die to the formation of fibrotic scarring in the donor holes.

1) Nice 2) ditto 3) Why do you stop it? Who cares if they bleed? Haven't you heard of the 'Rolling Stones'? Let it Bleed? 4) Yep, the aesthetics of hair transplant design is neglected in our discussions. For so long, it was accepted that we build from the front to the back. However, I think the invention of FUE changes the picture. 5) see above. 6) That's interesting. But are you talking about recipient areas? I'm talking about extraction and donor.

In case we need to clarify this.. Jotronic just said that, "The most effective way to avoid shock is to simply shave down ...(it) is truly the only way to minimize transection" Shockloss and transection get mixed up as usual. That's not Joe's fault, it is just part of the sloppy way we throw terms around in this industry. By way of metaphor, a) he died from shark bite and its associate blood loss, lost both legs, half torso b) He died from heart attack because of seeing the sharks swim around him c) He fainted out of shock at the sight of sharks and later recovered. All of these are lumped into shockloss. Can someone please invent terms that distinguish these from each other? Then we can discuss these better. About shaving. I've always wondered why shaving was preferred to buzzing. Buzzing would seem to give a better idea about the trajectory of the graft under the surface. No? If you look at the typical strip model in North America, say Hasson and Wong protocol (or former protocol). -Stop meds like Minox weeks (months) before procedure to reduce op bleeding. (Result - dying weak crown or minaturizing hair lose their lifeline) -Shave all potential recipient areas completely (Result - you cannot notice hair falling out due to shock loss post procedure because it was already shaved) -Plant in an even pattern through designated zones and leave other zones completely empty. (Result - are minaturizing hairs just trampled on in dsignated zones? Look at the planting pattern) I guess the silver lining to the strip cloud. Strips are usually front-loaded and the crown is often left 'for another day' so those minaturized hairs may recover when minox recommences. I would also like to ask about the scarring caused by small punches (<0.8mm) We are often reminded that fibrotic scarring caused by FUE scarring makes subsequent operations more difficult. (I don't mind if it is difficult personally - that is not our problem?? - or is it>) Anyway, it is not only strip clinics that remind us of this. Dr. Wesley, when promoting his scarless FUE (that is correct 'scarless') also points out that his technique will eliminate this problem. My first assumption is obviously not good enough. It was simply, a) The scarring forms in the 'tunnels' formed by the FUE extraction holes. This means no big problem, because next op, you don't mess with that area. So my next best assumption would be that. b) As the instrument bores through the dermis, the scores and cavities are created so that scar tissue spreads laterally away from the tunnels. This might create patches of friction that could mess with a doctor's interpretation of tactile feedback, but the days of manual extraction as a commercial force are numbered so, - what difference does this make to an Artas robot, the Neograft handler, the drill operator. Could it be yet again, we are being told that FUE is problematic? Finally, I never assume that FUE clinics, docs etc., are higher, better, less x or y. All docs are the same and I am in no position to judge.

Voxman, Holy .. You know, where I come from, it is a kinda weird cultural backwater, the tyranny of distance. All they did was sing American 50s songs. I think it was the hair. All of the British invasion bands had hair transplants on their Japanese tours. Did you know that? That Phantom 12 is so sexy but I know, to the type of girls I wanna be close with, that is as relevant as a golf club! But it was still relevant in white America in the mid-90s. See Youtube, Dandy Warhols, 'Heroin is so Passe' clip. (The song title is 'Not if you were the Last Junkie on Earth) Now that's a vox, and I don't think I'm gay, but I'd say that lookin' like that singer, with that guitar, was pretty much the code I wanted to crack, had I been ready and willing at the time. It looks totally pretentious, but because it was sexy they could get away with it with a certain crown at the time. I think Mick Jagger in 1964 is the guy. Howard Stern, interviewing Lenny Kravitz (who I suspect kissed Madonna) said, 'You've still got your hair' ! I became a 60s tragic in the 80s, and I haven't disengaged. I'm rusted on like a barnacle on a rotten ship's hull. I think Joetronic is right. Can't get over the past. Note to all people with strip scar who regret it , 'Get over it!' Thanks for your post Voxman. Don't get yourself another f(&)('&kn heart attack. I wanna talk more. Joe looks pretty good, and he's a good looking fella and all, but I don't care if he thinks strip served him well or did meds serve him well? If your crown is opening up, what serves you well? A shave? Woops. Strip scar. Getting stuck in the past anyone?

Hi Voxman, I should do that one day, but I feel it would take some meditation so that the tone of it was right and that it would do justice to the psychological and social stuff that is in there. Suffice to say. Getting an HT took a toll and changed my trajectory through life and I suspect it has distorted/stunted a lot of growth, whilst in a certain particular way, has taken me to a place beyond the average Joe. The issues I've had to grapple with are not popular party topics! I saw a pic in your profile. You would have been 19 in '69! Hence, the Vox right? Getting an HT at your age must be quite a different experience. I would be interested to hear your views on it too. And I must say, to be able to shave/buzz it off - what I would give - but for the strip scar. There is no changing society's verdict on a strip scar. So to all younger guys think carefully before you let them cut you an ear-to-ear scar.

For transparencey's sake?? That doesn't even pass the spell check! Luckily, I suck at anything to do with language, and I am dumb enough to to take the bait. Number one problem is the strip scar. Number 4,077 problem (and counting) is... ...the strip scar. I don't know about transparency, but from a basic pork and beans perspective, a strip scar = you had a hair transplant.

Such a brilliant thread guys. The take-away for me is that techs need to be trained to use implanter pens. Can they? Is it illegal, even in Turkey? From the little I just read yesterday (or whenever it was) it was slit size that did the damage. Even clumsy handling of the grafts might have been accommodated for with wider slits - as bad as that sounds. Slit size is a doctor's decision. It costs him/her nothing to make the decision surely. He/She thinks a) graft survival vs b) having nice 3 day post-op pics with clean heads, and goes from there. From what is being said here, the decision to use .5mm slits is a crazy. The more sloppy the tech force and the protocol, the bigger the slits need to be. So this is a case of doctor incompetence. Or are you people suggesting that techs now decide what size to make the slits? If that is happening now that IS a scarey scenario! Added to the poor decision - and I'm sticking to my hunch that the doc decided that - I think it is a case of economics-laws strikes again yet again. Can/do techs in Turkey now use implanter pens? Is that already happening? Can you, as a consumer, stomach the idea of that?:confused:

It indeed sounds like a poor protocol, but not one a technician would have arbitrarily made calls about in respect to parameters. Surely, it was the good doc's call about the .5mm slits? Furthermore, the choice to not use an implanter pen - a doctor's choice, not a technician's. We need to be careful not to conflate the issues here. Using technicians makes sense, if the laws allow for it.

Wallet Wise move, Don't mention the docs name. It does you no good. People asking for the name of the doc or clinic don't care about you usually. You compromise yourself for no good reason. Hopefully, only the bad grafts popped and you'll be fine. Your post is very valuable to us just as it is. No names is a smart policy. And watch out for the PMs too.

Open mind - research - bad news - human nature - horrible - facts - wisely - unrealistic. ! Love it. Let's sing it. D-O-N-T G-E-T A S-T-R-I-P S-C-A-R! That is the first and last page of your research.