consequence

Done at 5 months. When Bisanga hits, he hits.

3 hours ago, 1978matt said:

Back in 2014 he invited me to observe him perform a strip surgery (I was in the US on vacation and made a stop off on my return journey).

He makes the incisions one at a time while one tech (usually Lisa, but no idea if others do now) implants a graft.  Another tech is providing the grafts.  As it was a strip case there was at least another 2, maybe 3 techs cutting the strip and assiting with dressings, surgical tools, monitoring etc.

Interesting. So not really doing the procedure by himself but maybe like 75% if techs are helping with placement.

Couto didn't do any of the extractions on me, but all of the incisions and placement, not sure if he was different before or does different amounts depending on the patient.

Eugenix I *think* lets you buy a more expensive package where the docs do both extraction and placement?

Hattingen is also a husband/wife team and may be similar, not sure.

This is a very disappointing result and unusual with such great hair characteristics and young age. How are you looking now? Have you thought about a biopsy to look for lichen planus?

Any thoughts of PRP or repeat procedure?

Now at a year how are things looking? I'm generally not a big fan of going back to the same doc if they didn't get it right the first time.

On 6/3/2023 at 11:54 AM, stephcurry30 said:

Any follow up on this thread? Did OP get a refund? 

Spoiler alert: they never give refunds. 🤠

Unless it's an obvious breach of conduct, and in those situations only to avoid a lawsuit. For the case to go to trial, the cost of the procedure would need to be higher than the cost of hiring an expert witness. Or the patient wants to prove a point (even when the economics of legal action don't make sense) because they felt they were seriously harmed, ie. restorative justice. 

This isn't one of those scenarios. The results aren't perfect but they're not failed either. Just thin/whispy, which we see all the time, even with the "best". Hair restoration is always a roll of the dice, probably more so in the US than in Europe as of late but things are always changing.

In any case @washingtondc what did you end up doing?

35 minutes ago, Rahal Hair Transplant said:

I know it probably sounds compelling to think of a doctor doing the entire hair transplant procedure themselves. However, be careful with this kind of thinking. A doctor attempting to do an entire procedure himself would become exceptionally fatigued, and the results would be subpar.  The best results are produced by a dedicated and experienced surgical team, led by an outstanding and skilled hair transplant surgeon who performs the crucial part of the procedure, himself.

There are younger surgeons doing it with spectacular results. You're right though, I think it gets harder for surgeons as they get older because physical fatigue becomes a factor.

On 5/22/2023 at 7:05 PM, aNewHairHope said:

2.5mg/day. Has worked very well.

Here is some photos on a very bright day in direct light. Density deficiencies are more apparent.

 

Where are the density issues that are bothering you? Along the left hairline still?

Man can you imagine being a Norwood 0 and then getting alopecia universalis from COVID right as you're starting your career as a hair transplant surgeon?

His story is insane.

But yes, there's no way to judge without patient postings, we are a generally patient posted result based bunch. But he is young so probably needs a little time to develop that McDonald's level efficiency that you see with world class superstars. I'm sure they'll start popping up sooner or later if he's got high enough volume.

I thought there weren't studies on PRP with FUE but I found something -- this is a peer reviewed study on PRP with FUE showing good effect. They used the "Y Cell Bio PRP kit".

Particularly interesting was the faster growth/thickness and shorter catagen phase after surgery (ie. the infamous "ugly duckling phase" we talk about, also called the "desert" on the Spanish forums). Pretty hard to get past the numbers:

It seemed like it moved things forward about 3 months and helped save borderline follicles.

Non PRP:

PRP:

This was with a particular surgeon and a particular kit, larger studies need to be done.

--

And below is an interesting comparison of different PRP systems that seems to suggest Emcyte as the most effective as far as platelet concentrations:

However, the optimum dose of PRP for hair growth is unknown. Too much and you could actually kill the follicle instead of helping it grow.

Quote

Of the 33 systems and protocols we analyzed, only 11 met the definition of PRP as defined by Marx et al as having a minimum platelet concentration of 1 000 000 platelets/µL. Additionally, Marx et al and others have stated that platelets in PRP should be concentrated to at least five times that of baseline to be efficacious2 —only 10 of the 33 systems and protocols reviewed met this definition. Lastly, 3 of the 33 systems and protocols reviewed even resulted in a final PRP product with a platelet count less than that of whole blood, with a PRP platelet factor increase of 0.737 with Biotechnology Institute PRGF-Endoret,24 0.65 with Curasan AG24 and 0.52 with Selphyl. Of the systems analyzed, Emcyte GenesisCS had the highest platelet concentration tested at 1643±421×103 /µL.30 The lowest platelet concentration was 88×103 /µL with Selphyl.29 This variable range highlights the importance of system selection and protocol adherence.

However, an optimal platelet concentration for PRP has yet to be identified. More is not necessarily better as too high of a platelet concentration can be detrimental to the healing process....a lower PRP platelet concentration (2 000 000/µL) exerted positive effects, while the higher PRP platelet count (5 000 000/µL) was harmful to healing.

So basically who knows. I asked Dr. Couto which kit he uses to see if someone nearby has the same one, but haven't heard back.

On 10/31/2023 at 12:57 PM, consequence said:

The reason the specific clinic giving the PRP is important is there are a lot of protocol variations because there are no "best practices" for hair growth yet. For example, one of the things Dr. Couto emphasized to me was that his machine employed a very gradual increase in the blood centrifuge rate over time, not an abrupt increase to maximum speed all at once. The clinics near me don't have the same PRP equipment and their devices seemed to abruptly accelerate to maximum speed, though I'm going to ask to observe the centrifuge next time I go in.

I would imagine the more gradual incease in spin rate causes less physical trauma to the blood sample, and presumably less blood sample activation/inflammation. If trauma makes cells burst, for example, they're going to release all sorts of inflammatory debris. The infamous "shock loss" or telogen effluvium. So when you say "It can't hurt." part of me says, "Can we really say that?" 😇

These are the variables that vary with different PRP techniques. I think we owe it to ourselves to try and establish a standard in hair restoration, though it will probably be a decade or two before we reach a consensus (ie. head to head placebo controlled and double blinded trials)

It would make sense for different kit manufacturers to conduct these tests as the blood comes from the patient themselves, so all the major cost would be machine use time. Would not be a difficult study. And whichever manufacturer did it first and most conscientiously would have a dramatic uptick in sales that would more than justify the labor cost. Get it together transplant industry.

Another Pekiner hits 10/10 by 6 months. And with lighter hair too.

Goddamn world class.

Might be my new pick for best in Turkey.

@pb0896 did your density work out or did you go back for a second pass?

@Madhur Vansilupdate please

17 hours ago, ITA said:

Pekiner fa tutta la procedura da solo, è chiaro che non fa megasessioni, ma divide i suoi interventi in 2 giorni e impianta un massimo di 3500/3600 ( maybe even less) unità follicolari.

"Pekiner does the entire procedure himself, it is clear that he does not do megasessions, but divides his interventions into 2 days and implants a maximum of 3500/3600 (maybe even less) follicular units."

On 6/17/2022 at 8:02 AM, IMM1979 said:

 I dont trust any comments about hair clinics on this forum. My view is stronger than ever that its a herd mentality and people follow each other without conviction or real opinion. The stock market is the same. My impression so far is people on this forum get paid from promoting certain clinics. 

That's not an unreasonable analogy, sometimes it is hard to separate the marketing particularly with Eugenix, etc. The other side is that surgeons who aren't paying the subscription fee for "membership" don't get the same support and are obliquely criticized.

But we have to be realistic. This isn't Wikipedia -- the site doesn't run on user donations. You have to just keep this in mind and focus on the patient posted results. After awhile you get a sense of which comments to ignore, but sure it can be easy to be covertly swayed.

But these are truly spectacular results, you were essentially done by 5 months. Wow.

On 2/7/2023 at 10:41 AM, Rafael Manelli said:

Has anyone ever seen a bad case from Konior ?

Every doc has cases that don't come out well, Konior is no exception. There are no gaurantees in hair restoration.

This is a great case though.

Looking great dude. Damn. Maybe there is something to this Viagra/Cialis protocol.

A lot of medical advancements are by accident.

5 minutes ago, jjalay said:

I think you have to take into account the former situation of the patient and how he was before any ht and the number of grafts that were used for such a small area before making any judgments.

Yeah I just don't see it. I appreciate having high standards but this is just unreasonable.

Multiple people on the forums have explicitly stated Zarev and Ferreira do the extractions and placements without technician help. The others I mentioned I'm not as sure about, would love to hear from actual patients.

It probably results in higher consistency because techs can change so much.

41 minutes ago, Melvin- Admin said:

Dr. Lorenzo does not do the procedure himself. Techs do all extractions. There’s no surgeon that does it all themselves. Technicians are always required to a degree. To sort grafts, to help place grafts. 

I'm talking about surgeons that do the extractions and implantations themselves. There may be techs behind them sorting the grafts, but looking for practices where the only person that touches your head is the MD.

Don't leave us hanging @Rooter! Did the lagging areas flush out? 

Hopefully you come back one day and update us.

Quite a jump between 5 and 6 months. It seems that a lot of people see a difference around this time (except me at 5.5 weeks :/)

Happy growing.

How's it looking?

4 hours ago, gillenator said:

Dr. Konior does 100% of the procedure himself?…really?

No idea if he does currently. I believe at one point he did but would love to hear from one of his patients.

2 hours ago, streethawk said:

Dr Laorwong is fully involved in all aspects 

"Involved" is kind of ambiguous. He does the entire procedure himself or uses techs?

I think you might get the Golden Greed Award. 🤢 Your result from HLC was a 10/10 and is one most people on this forum would envy, myself included:

Just smooth af. And I know you know that I'm not one of cheer squad posters, this was legitimately amazing. If there wasn't a financial ulterior motive to your earlier complaints, I wonder if you have a bit of hair dysmorphia.

But no matter, we're here now. Based on how well you grew with that prior you should be golden once again this time around. The temples he gave me I would pray at.  ☺️ 

But no more hair surgeries for another 15 years. Save donor for your mid scalp and crown.