bverotti

I suggest you may want to contact dr. Ilter. I have personally seen him extracting afro curly hairs with no problems. IMHO some people intentionally put out false information about FUE. Maybe it is because they dont know better, or I guess some politics are at play.

Let me clarify for you, In my opinion, the total area of the implant zone is at least 100 cm2 (most likely larger). You harvested 3600 grafts total from your strip. In the case where all grafts where implanted at the same density over 100 cm2 it would proceduce a density of 36 grafts per cm2. Obviously a higher density is used for the frontal area. Most surgeons will alway put highest density in the frontal area, lowering the density going to the rear. Let's assume you received 70 cm2 in the hairline. Further lets assume your hairline is 20 cm long and 1 cm wide. Just this small area of 20 cm2 would eat 1400 grafts, leaving you with 2200 grafts to cover the remaining 80 cm2 with an average density of 27 grafts per cm2. 30 grafts per cm2 is usually considered a minimal coverage. This makes perfect sense in the way that you have described your results and progress up to now : hairline ok, but behind the hairline it is quite thin. Looking at your comparison pics I can see a huge improvement, I would be very happy with your result !

I believe technically this is a very good job, well done. However I do believe that 70 grafts cm2 is somewhat exagerated. You treated area is AT LEAST 100 cm2, most likely larger. Putting the numbers in place I can not see how you get 70 grafts cm2.

Hehe, where your really treated on the 4th of Juy? Isnt that a big holiday in the USA ? What bothers me a bit is the fact that you seem to expect the HT will be giving you a similar effect as a hair piece. In many cases it will not. HT's are usually less dense than hairpieces, someone should have mentioned this. In case of high NW level, HT density will not even come close to hair piece density. On the other hand, 7 months is way to early to draw conclusions ... relax buddy, take a break ! You will definately see improvement over the next couple of months.

Typpically patients do not show themselves at work the day after their treatment. From my experience most patients are trying to cover up and hide any proof of a procedure. However I always tell them that people will notice sooner or later that more hairs are growing. Many of your college or friends will be kind enough not to mention anything, but trust me they will know. And what is so terrible about having back the hairline you once had anyway ? I had 1 friend who teased me about my HT. Many years have passed, his hairline disappeared, and now he got his own 2000 grafts done not to long ago.

Sorry to bring the bad news, but your hair situation at the age of 18 is severe. In fact, I would be surprised if you don't go full blown nw7 by the age of 30. Propecia may slow down your hairloss, but even propecia has limited effects imho when faced with your age and very agressive hairloss. I would not recommend a HT, I do not believe it is in your best interest.

What comes next no doc has answered me. I had pretty bad psoriasis on the frontal and mid scalp before my HT. After my first session it had almost disappeared, completely gone after my second procedure. It never came back either. I do not recommend doing a HT for treating psoriasis however

I my opinion the question should be : who has the most experienced techs that know how to perform high density placement? Sure, making high density slits is not easy, but filling them is the most crucial part. High density placing requires loads of previous experience. It is right at this level where grafts are lost by squeezing or overmanipulating. We require our techs to wear magnification glasses for safety reasons during planting. If you dont see 100% what you are doing it is bound to create trouble.

I just want to add 2 docs : dr. De Reys and Dr. Ilter, both FUE only docs. Interesting to notice that out of the 8 names mentioned in this message, 5 are performing in Belgium. Obviously it makes me proud that being a Belgian myselve such small country has become the European headquarter for HT ! Just to illustrate how small country Belgium is : You could visit ALL institutes mentioned here in 1 day !

Indeed, when FU as very close to one another a large punch (anything greater than 0,8 mm I consider to be a large punch) surrounding follicles could be damaged in the process of extracting. I believe dr. Bisange once presented a study about this. Of course you would think transection rates would go up when smaller instruments are used. But look at it this way. A major leage pitcher can throw fast balls inside the pitching area all night long with almost no misses. I doubt most non proffesionals could pull this off. These pitchers have developed a feeling for the ball, the distance, the pitching window. It took them many years to develop this Jedi like feeling. Give them a smaller ball and I am sure that after a short while they would get the same score. The learning curve would not start from zero. Same goes for FUE docs. Most start by using 1 mm instruments until they get the feeling in their fingertips. Give them smaller tools and they will adapt quickly. I can not explain it better, I do not perform myselve ... that is how the docs describe it to me.

Hehe, you can't have it all ! No, I dont believe that it will be possible given the example you have given. However, I managed to get 4000 FUE grafts after 1 strip session. According to our docs I still have 1000 or a bit more FUE in my donor area without risk of thinning. I must say I had an over average donor supply to start with.

If you had asked the question how many FUE are available to the average person a couple of years ago the answer would look much different than today. First of all today most top FUE docs are using smaller instruments than before. Obviously this has no impact on the total number of available follicles. However by using 0,7 mm or smaller instruments surrounding follicles remain untouched. This is very important for guys with high density. Another factor is that FUE docs have picked up speed by performing it on a daily basis. I can not run a marathon, but if I practice for 12 months I am fairly sure I could pull it of (if I dont get a heart attack during the race). Give it 2 more years of practice and I am sure my time would improve tremendously. This is more or less what has happened the last couple of years in the FUE field. So, instead of doing 3 consecutive days for 2100 grafts (like I did in 2003), experienced FUE docs pull it of within 1 day without having to stretch the limits. Last year we really started doing a lot of 3k sessions (over 2 consecutive days). Most of the patients report us that their donor density is visible unchanged, can't even feel a difference when running fingertips through the hairs. This year we are going to see more patients come back to add 1000-2000 grafts on top of what they already got. This means that some patients will go for 5000 grafts FUE only. Obviously we tell those people that they should not expect an intact donor area when shaven to the bone. White spots with missing hairs will become visible at some point. However at 3 to 4 mm length it should be fine (we will provide more picture proof as soon as we got it). We believe that today the average FUE patient will be able to transplant 4000 to 5000 grafts using FUE only with no worry about linear scarring, nerve damage, scar stretching, phantom pain.

Sorry to hear this. To be honoust I have never heared of anyone losing grafts in the way you discribed after 17 days. Acording to studies grafts are well in place by day 6-7. I would be interested to find out what happened and what was done to resolve this problem.

Very good question. A good HT starts with a thourough information session for the patient before his treatment. He needs to know that (in most cases) a full hair restauration is not possible. Patients that have been doing research on the internet usually have a good idea of what is possible or not possible. Having said that, some people just dont seem to listen or understand what is being offered ... and still wind up unhappy.

Donor area of a patient that shaved down to the bone 1 year after his FUE session. As usualy dr. De Reys used 0,7 mm punch to extract the grafts. Please note the the red spots are psoriasis, nothing to do with the transplant. I brightened up the image a bit to make it more clear (the original was a bit too dark).

Technically you are correct however, what you are leaving out is that harvesting more grafts via FUE will most likely leave the average patient looking like swiss cheese. Therefore I would suggest that one could extract on average just about as many grafts with Strip as with FUE. I believe we agree on this point as per your last statement. FUE may NOT leave obvious scars, but I'm not sure I would go as far as to say that it doesn't leave visible scars. That would be like calling a procedure "scarless" which isn't true. I think it is safe to say that at best, FUE scarring may be less obvious at skin level than than a typica strip scar. However, I have seen some bad strip and FUE scarring cases. In the hands of a proven quality hair restoration physician, these risks are minimized. Bill Bill, I agree with you that FUE is not a scarless procedure, anyone who claims otherwise is stretching the truth. We all know that cutting the skin will leave some kind of scar. But there are scars and there are scars. Some remain (highly) visible, some are hardly visible (example > no visible scarring after an injection). To date one has to accept some form of scarring when considering a HT, period. Indeed, I agree with you that the numbers available for strip and FUE are about equal for the average patient. FOX test : This test was an initial attempt to find out who is a FUE candidate and who is not. This test was developed in the early FUE stages when there was little experience. Dr. Jones discarded this test during the ISHRS in Vancouver for the following reasons : you could to a few extraction in an area to find out if the grafts come out easily. This test however does not take into account that hair directions change. So someone could be FOX rejected, but if the test had been performed in another area of the scalp the FOX test would be positive. In our opinion there exist no such thing as a non FUE candidate.

I would like to take the opportunity to answer your questions taking into account OUR experience, obviously we can not account for other peoples experience. 1. If you are asking about maximum amount of grafts harvestable : strip is limited by laxity, FUE is limited only by the patient accepting thinning donor area. Technically it is possible to harvest many more grafts using FUE, I doubt anyone could question this. At this point we believe that FUE produces about the same amount of grafts when compared with strip surgery, on average 4000-5000 grafts. 2. Looks maybe a little high on the crown, the sides seem ok. 3. No, FUE may not leave visible scars, but at a certain point missing hairs will become visible as white dot like areas. But even this will be MUCH less visible at bic lenght then even the best scar or tricho scar 4. You wont know how the scar will turn out until 6 or more months after the session. I have no crystal ball, but personally I would not count on FUE scar filling to make the scar invisible at bic level. I have seen FUE scars filled with no result, most results are good in 'softening the scar', rarely the scar is invisible after FUE'ing them. Again these are our opinions that are based on our experience doing FUE on a DAILY basis.

Example of patients error : I know of 2 cases where patient where responsible for less regrowth. 1. Hit the head while getting in the car immediately after surgery 2. Hit the crown on a low level ceiling 1 day after surgery. Both patient lost some grafts immediately. It was not possible to place them again because they where contaminated and of course long dried out. Althoug both patient lost grafts it did not affect the result in a visible way.

Dont worry about the depth, if they go tooo deep you will start saying strange stuff and white gel like blubber will suddenly pop out from the holes. But dont worry, if you survive the hair will grow

There was no discussion among the docs wether or not more tissue had to be cut out using tricho closure, that is an accepted fact since it is part of the tricho procedure to bevel the edges. This extra tissue is just a few mm, but again these couple of mm could make a major difference for the next session. The discussion was about wheter or not the tricho closure should always be used. As far as I remember there was no consensus about this question.

Bill, I was attenting the advanced surgical course at the Ishrs in San Diego last year when exactly this subject was debated among the surgeons (I was the only non surgeon in the room). I am sure coalition doc can put some more info here about the technical side of it.

My advice : If you are worried about a donor scar, dont go for FUT. That will settle it, you need not worry at all.

I believe it makes more sense to use the tricho closure when going for maximum numbers. During tricho closure more tissue is cut and thrown away than during a normal closure. This might haunt you in 5 years when you might be faced with less laxity ... and thus less grafts.

After my last densification I am able to wear my hair like in this picture. Before my last session it would so thin that it makes no sense to have it like I have it nowadays. Still, it is NOT my 18 year old density, in fact compared to what I had back in the good old days this would still look thin. Maybe you young folks dont want to hear it, but I had Elvis type of hair density ... and lost all between 29-31 so don't think it can't happen to you ! Moi, before close to 6000 grafts.

Very well Said !!!