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spoon

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  1. I completely understand that this can happen in a one-off case. But the main point I am trying to make is that these kinds of questions are ideally answered with statistical techniques. With large enough stratified samples we can get a very good understanding of where different clinics fall on the "hairs per FU" map and what their philosophy is regarding how small grafts should be cut.
  2. I think that the discretion and philosophy of the clinic in determining graft size is being underestimated. Your specific yield of singles/doubles/triples is largely dependent on how your clinic cuts grafts. You might have had a very different distribution at another clinic. This is why we turn to statistics and if clinics were willing, they could each show very easily what the average distribution is when they perform surgeries. They could even categorize them by ethnicity which would really provide some insight. It is my very strong opinion that certain clinics systematically perform surgeries with fewer hairs per graft than other clinics. By systematically I mean it is their philosophy and practice to cut grafts smaller than other clinics might. A statistical analysis would demonstrate fairly conclusively whether this is true or not.
  3. Dewayne - good questions. First of all there are philosophical differences between clinics about things like session sizes and dense packing. Keep reading and researching and you'll quickly learn what those are. Risk isn't really an issue at top clinics and generally speaking it's always better to get as much done as possible in one session. Less downtime, less overall cost. You should know though that a megasession, even 2500 grafts, is a long, long day. However one big philosophical difference can be the question of what constitutes a graft. Unless you know the average graft size of the clinic, on average, over the course of many surgeries, you aren't comparing apples to apples. It has become very clear to me over the past three years or so that the "2.2 - 2.3" hairs per graft benchmark is no longer accurate in many clinics. I am not accusing anyone of sub-dividing FU's however it is very apparent to me (not so much to some others) that different clinics have different ideas of how big, on average, grafts are. I don't think the basis of these distinctions is money, incidentally. By way of example, if your 2500 graft session has 2.2 hairs per graft, you'll get 5500 hairs. If your 4000 graft session has 1.7 hairs per graft, you'll get 6800 hairs. Now, 4000 grafts is 60% more grafts than 2500 grafts. But 6800 hairs is only 24% more hairs than 5000 hairs. To put it another way, if the clinic that estimated 4000 grafts (6800 hairs) was able to generate 2.2 hairs per graft, your session would really be 3091 grafts, which doesn't sound that far off from 2500, does it? Personally I have seen surgical results with reported hairs per graft as low as 1.5 or 1.6. At the other end of the spectrum, particularly with doctor's using coupled FU's, hairs per graft can exceed 2.2 or 2.3. The challenge is to get the data.
  4. I think starting and then stopping Rogaine would be a big mistake. Your hair will get dependent on it and then when you stop you'll have a massive shed.
  5. This is absolutely true. When you spoke to the doctor and he assessed your donor on a scale of 1 to 10, your "score" would have taken into account the thickness of your hair. This is not what I'm trying to say. These things certainly matter, it's just very important to understand how many hairs you're getting when you get a quote in grafts. Your first post that started this topic referenced graft counts. What I'm trying to explain is that you really need to know is this: if you hypothetically went to different clinics and each individual clinic transplanted the exact same number of HAIRS, would those clinics also transplant the exact same number of GRAFTS? If so, then you have apples and apples. If not, you have a fruit salad. Hairs are absolute, grafts are interpreted.
  6. No I'm not talking about them specifically in the hairs-per-graft context. That clinic has published inflated estimates, but they aren't attaching any hair counts anyway so the inflated estimates are also meaningless in addition to being complete fiction. As is the claim that FUE surgery is non-surgical. But I digress. They should be but they don't. Like I said you can look at the numbers yourself. Some strip cases posted on this board show less than 2 hairs per graft (as low as 1.5 or 1.6), some show more than 2.3 hairs per graft. So until clinics tell you how many hairs they are talking about transplanting, it's pointless to focus so much time and energy on measuring donor quality by the number of grafts you can get. It is more sensible to try to estimate the hairs per cm2 density you can achieve and the coverage you can obtain with varying hair densities across your head to determine how much or little a transplant will help you. There's one other piece to the puzzle and it's the shape of the strip. If a doctor is protecting against a possible future NW7 then there's a very specific and somewhat restrictive shape that the scar has to take. Look at the next few NW7's you see and imagine what their strip would have to look like to avoid being exposed by recession to see what I mean. In my opinion doctors should plan for NW7 in more cases than not.
  7. Not specifically. What I'm saying is that you shouldn't get too caught up in the "number of grafts" because that doesn't mean much anymore. It USED to mean quite a bit when the average number of hairs per graft was generally between 2.1 and 2.3. Lately however you can look at the cases presented and see for yourself that hairs per graft can be around 1.5 or 1.6, all the way up to over 2.5. Let's put it this way: let's suppose you have 18,000 HAIRS available for transplant. In one clinic, that could be 7,826 total grafts (2.3 hairs per graft). In another clinic, that could be 11,250 grafts (1.6 hairs per graft). Your donor didn't change at all, but your graft count is 44% higher in the second clinic because your hairs-per-graft count is 44% lower. Your question is how good is your donor - a doctor has told you what he thinks and without seeing it, I can't really offer an opinion. From my own observations (and I have observed a lot), it is a cruel irony that as your norwood increases, your donor amount and donor quality both decrease. In other words the guys that could most use hair transplantation have the least donor to work with, and their donor is generally thin anyway. It's rare to see a NW6 with thick donor (again, my observations). Laxity is a pretty big deal also but it's less important because you can somewhat influence it by doing the exercises. Unfortunately no amount of exercises is going to increase your donor density or hair quality.
  8. This conversation is meaningless unless you include the hairs-per-graft and how many hairs per square cm you'll need to get the look you want. Techniques have changed. But technique or no technique, graft estimates are being inflated by a certain clinic in Toronto. Graft counts are being inflated by cutting smaller grafts.
  9. Maybe he meant the left side of his DONOR was virgin? That's my interpretation.
  10. B Spot - Dirge said "no more punches or strip grafts". Someone confused that with "strip surgery" so I wanted to clarify that "strip grafts" and "strip surgery" were completely independent terms. As to your question I couldn't say if he still uses them. According to Dirge he does not. I've seen in the past that websites can be very, very out of date. Look no further than Dr. Cotteril's and I know you are personally familiar with that one. Unger is a legend but a doctor's website is the way they get their message out. Right now his website is awful. If Dirge's comments are accurate then the website does not reflect the current practice.
  11. Dirge, I'm still not getting it. You say here that he no longer does strip surgery? So is it only FUE surgery he does now. You say he only uses Follicular Units which is good but how does he harvest them from the donor area? If he no longer harvests via strip then they must be taken individually by Follicular Unit Extraction (FUE/FIT) with a small punch? In this context "strip grafts" means "slot grafts", not "strip surgery". You can easily do a search on this term to see that it is basically a minigraft but once upon a time it was the state of the art for transplantation. This term has nothing to do with the strip harvesting method per se. FYI Unger was a pioneer in the field and one time was one of the foremost authorities on hair restoration in the world. He probably still is one of the foremost authorities in terms of knowledge and experience but times change and like with any other thing where economics are involved, and there's money and success to be had, competition catches up quickly.
  12. It may look even in a post op pic but that's really not relevant. The main thing to realize is that the transplanted hair is never going to move or thin out whereas it is very clear from the pic that the rest of the forelock area is going to vanish. So even if it looks okay right now, it's going to look bad some time in the near future unless he has more work done. The good news is that it's easy to fix, as long as you accept the idea that an additional surgery is "easy" .. which it isn't!
  13. Yes and no. It looks clean but unless the guy has another procedure scheduled pretty soon he's screwed. The native forelock is extremely weak and the pattern that was transplanted is going to look brutally un-natural when it grows in and the native hair behind it disappears.
  14. He doesn't promote himself online so you likely won't find much information but from everything I've researched he does great work.
  15. It is insane to even think this. First of all your posting behaviour isn't remotely similar to that of a clinic employee. Second, if you did, which you don't, you would have disclosed it. Now that you mention it .... Hah. FYI - In Dr. Seager's paper on micrograft size he said he generally observed 10% one-haired grafts, 50-60% two-haired grafts, and the remainder obviously three/four/possibly five-haired grafts in Caucasian patients. "Refinement" has nothing to do with hair counts per graft, so I'm glad that was corrected. Furless - semantics aside I would bet on you having an excellent result with excellent density.
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