bverotti

I would guestimate around 1900 grafts or so to do the job. First lines require high density and the further backwards generaly lower density is placed.

To answer some points in the list of supposed problem with FUE Traction force : In the hands of our surgeons we do no see this problem at all, very simple. The surgeon will know through experience how shallow or deep to perforate in order to have the graft slide out easily. For beginners this could indeed be a temporary problem that can only solved by : achieving expert hands and using proper instruments. IF the twisting and tortion force would cause such great follicular damage we would have noticed it also in our results ... nature has a way of showing us when we are doing things wrong. We do not see any such evidence in our results, sorry. Tearing of shearing grafts: Indeed, some hair characteristics like tiny grafts are more difficult to extract. An expert FUE doc will recognise this situation immediately and adjest his speed/angle/depth/speed. The answer to this pitfall is .... experience. Instruments: Many will try to impress with patented tools, voodoo tools ... what not. No, we just use of the shelve instruments that anyone can buy, period. We do agree that surgery should not least over 12 hours. In our office it is extremely rare that we go over this limit. I read on another board however that a 4100 graft strip session took 12 hours to complete, what happens to patients who are lucky to get 5000-6000 grafts ? Lying about the actual numbers : We offer our patients to inspect the grafts and count them, no secrets here. Splitting only occurs if there arent enough single grafts for the hairline, otherwise the grafts contain 1,2,3,4 hair grafts and are reimplanted in the same way. Dr. Ilter gave a presentation on his FUE last year during the ESHRS. I believe some coallition members where present as well. During his speach he informed how he had started with small FUE sessions and slowly changed routines and instruments in order to harvest up to 3000 unsplit grafts with virtually no transections. I spoke to many docs that where attenting and they where truly amazed by what they heared. On the other hand they could not imagine how it is possible to keep up concentration for such a long period. If you ask me about FUE problems this one is key : fatigue. Most docs starting with FUE will be tired after only 1 hour. Just like a runner has to build up his strenght a doc should therefore train train train and eventually he will be able to concentrate very long hours. At a certain point they become so experienced that performing extractions is no more that walking .... you need not think about how to do it. STrip distortion : underneath the stripped skin the follicle direction is often very distorted. Normally the doc knows the angle and depth, but in patients with previous strips the direction and depth is sometimes extemely distorted by the pulling and traction forces caused by the attempt to close the wound. This is a problem and therefore it is again advisable for people to start HT using FUE. The more previous strips the more distortion is noticed ... what is very logical.

I do not deny that in terms of shear numbers, FUT still has the uperhand IF you opt for a handfull of surgeons worldwide (most docs still perform strip sessions of 2000-3000) On the other hand it is technically possible to achieve 4000-6000 graft sessions using FUE over a couple of consecutive days. The reason why we are holding back is because we take a step by step aproach. We are unsure about the effects of such sessions on the donor area. The major questions being : if you harvest that many grafts in a short time, will we no risk donor area shockloss ? So instead of rushing in and perform giga sessions we would like to slowly move forward with this, I dont think anyone will object to a conservative aproach. For the sake of arguments let suppose for now that such giga sessions do not produce any side effects. This would mean that almost ANY patient, regardless of laxity could achieve 4000-6000 grafts in 1 session, that would be a fantastic breakthrough, not ?

You know, when you attend the ISHRS advanced courses, a large portion of the time is spend on how to deal with strip problems : how to avoid too much tension, suturing techniques, widening scars, tissue damage/waist, nerve damage, pain control during and after the procedure, excessive bleeding ... It is generally accepted that FUT has inherent and build in potential risks for the patients. With the vast majority of surgeons performing strip surgery for many decades you would think a 100% solution for all those potential problems would have been found by now, unfortunately nothing is further from the truth. Read the potential strip problem list again and then think about FUE, get it ? The only problem with FUE is that it takes time to acquire the right skills, lotsa time. Most are unwilling to spend it due to costs and longer working hours. IMHO one can not oversee the potential benefits of FUE over any other kind of hair restauration technique offered today. The proof is in our pics that we present and from others that are dedicated FUE experts. Obviously we will continue to post FUE results as a backup to our words.

From my visits to several advanced surgical courses during the ISHRS I know that strip grafts average 2,0 hair per grafts. When we extract grafts using FUE, for example 2000 grafts we average 2,3 hairs per graft. 2000*2,3 = 4600 hairs for FUE grafts 2000*2,0 = 4000 hairs for strip grafts That is more than 10% difference.

Bill, Here is a list of surgeons that I know disagree with most points made in the article 'potential problems with FUE' Dr. Ilter Dr. De Reys here is a list of surgeons that I believe/suspect will most likely will disagree with the article : dr. Cole Dr. Woods dr. Hussain dr. Armani Please notice that all of the docs mentioned are FUE experts, not offering strip, or not offering strip anymore. Furthermore notice that all of the above use different techniques, or at least claim to use different tools - technique - routines ...

She can draw a hairline in reponse to the docs request. He then inspects this line, makes adjustments, calcs the density and asks the patient for his approval. So its not like she takes everything in her own hands, it is a mutual job shared between the team and the patient. In our case the assistant has major experience drawing hairline through varies training from docs and courses at the ISHRS.

The donor area safe zone in the picture is still full with saline, giving in the impession that it is much hihger. We believe the safe zone is safe up to nw6. Patient was also adviced to go on meds to prevent further thinning in the frontal area, he had no signs of thinning anywhere else. The hairline was planted with a density of 51 graft per cm2.

Bill is right, too soon to start with an HT, give meds the preference.

Yes, we average a maximum session size of about 3000 grafts, unsplit. Guess what, most strip surgery average .... about 2500-3500 grafts, split. Yes, I know you have the exeptions, but that is not the rule. I was more thinking about yield in terms of % of regrowth however, I guess in this case you would agree with me.

This is a blunt statement. In the right hands both procedures produce equal yield, period.

3000 grafts and NO 3 and 4 hair grafts ? In my opinion highly unusual.

The thing about hair surgery is that only local anesthetics are used and patients typically hear and see almost everything that is going on (which I believe is a good thing). During most surgeries patient are put asleep and dont know a thing what happened to them ... and if you know some surgical assistants than you should talk to them, you wont believe your ears when you find out who is doing what during surgery. One of my best friend is an ER surgycal assistant and sometimes I believe patients are bettter of not knowing what is going on.

Ex strip patients have already a large chunk of donor area removed, meaning the donor area is smaller to start of with. Secondly our surgeons often find that the natural angle of the grafts is often very distorted by strip surgery (unterneath the skin, not visible), making extraction more difficult. On the other hand, all virgin patients will get the numbers paid for, be it 2000 or 3000 in 1 day. These numbers are created for the 'worst' case. In fact we could do more in a day, but we need to know in advance that what we offer is achievable. A French patient was very sceptical about our counting a couple of weeks ago. So we agreed that his father would sit next to the counting assistant and verify everything. As promised he got 2000 grafts (2043 to be exact).

We're discussing this in terms of one SINGLE session; meaning one SINGLE day. What is the most amount of grafts you guys have moved in one DAY? You guys always advertise one SESSION, but we later discover it was spread out over several days, and even then have you guys ever moved 3K in FUE over two days? If so, how was the yield? Even *if* the yield was acceptable I personally wouldn't put my donor through the excessive trauma & scarring in the event that I needed a significant # of grafts in the future because of future loss. Dr. Ilter and his team perform up to 3000 grafts in a single day on virgin scalps. Dr. De Reys largest sessions by now is about 2300 grafts in a single day. By the end of the summer we expect to increase our official maximum per day to 2500. Ps : I am talking unsplit grafts.

Figure this. It takes 3000+ strip megasessions to become a respectable strip doc. If you do 3000+ FUE grafts you become an unrespectable doc ? Not sure if my interpretation is correct, please explain ?

We give our patients pure aloe vera to spray on. In fact we even spray the recipient area with it immediately post implantation. Thereafter we ask the patient to spray 3 to 5 times daily until the bottle is finished. Aloe vera is one of the finest extracts ever to have been discovered in regards of skin healing.

This thing called hair surgery is not always a clear path. There are many many variables that nobody can predict. Redness and time of regrowth are just 2 of them. I have seen cases where the redness was gone just a couple of weeks after the treatment, other cases it took almost 6 months ! I have seen regrowth after 6 weeks and there have been cases of initial regrowth after 6 months. You are well within limits and from what you write I am sure it will work out fine for you. During my consultations I often ask what people expect to be the hardest part of a hair transplant. Many answer the pain of the injections, the fear for the unkown... In fact most people tell me that waiting for the final results itself is often the hardest part :-)

Based on actual results and witnessing many many pocedures, as opposed to talking about it with other people: No need to EVER use an instrument larger than 0,8mm. 0,7 gets the best out of 2 worlds : minimize tissue damage and still get all size grafts out intact. BV

I would have suggested to start with 2500 or more by FUE method. Depending on your wishes you may even need a follow up session for another 2000 or more.

Very good post, I particularly like the spagetti comment. When patients want to have grafts implanted between existing hair we also prefer to shave the recipient area. The patients spends a lot of money and wants the best possible result. Being able to see clearly what is going on is key, like pointed out by dr. Lindsey. Implanting between existing hairs is almost like asking to perform the placement with the lights turned off ... it is possible but it certainly not in the patients best interest.

My guesstimate would also be around 3000-3500 grafts, nothing less.

Being that hairloss is progressive and unpredictable, a one session done all is close to an illusion I am afraid. First of all further hairloss causes many guys to get a follow up treatment. Secondly, hair gread is certainly a factor that gets many guys push the envelopes.

Looks good, please post some pictures with bird eye view.

Burt, I met Futzy a couple of years ago in Vancouver at the H&W party, and he looks just like he does in his after pics.