A vEry saD 8th month update ..

[Topcat611]

Why would you even consider going back to the same doctor?

 

I agree with you on not having another strip. People just don't understand how big a deal it is to have a chunk of scalp cut out of the back of your head. But then it's always the patients that have only had experience with strip that seem to promote it.

 

I have had strip, 4mm punch grafts, scalp reductions, scalp lifts and fue with scalp, body and beard hair. Find an experienced fue doctor that has skill, natural talent and ethics. Then just do a small procedure to test the waters.

[Bill - Seemiller]

I appreciate everyone's contribution to this topic.

 

Like everyone else, I truly feel for Mr. NK and predict that he's not going to have optimal growth. While it's always a good idea to wait a year before evaluatig the final result, I suspect his previous necrosis may have damaged many of the grafts and thus, hindered the final result.

 

There are always a few die hards who insist on blaming hair transplant doctors or the procedure on these types of posts which is highly unfortunate. Every physician has cases of less than optimal cases and rare conditions like necrosis can occur no matter how good the surgeon is. That's why these possibilities are disclosed prior to proceeding with a procedure.

 

The best way to help this patient is to provide him with sound advice and provide him with the facts. Slamming quality hair restoration physicians or going on an anti-hair transplant campaign is counterproductive.

 

Mr. NK, I think you're doing the right thing by waiting a couple more months. But you do need to prepare yourself for the high possibility that your growth will be less than optimal. At that point, you will have to decide what you want to do next. I have confidence in Dr. Mohmand's ability and trust he will take good care of you for future procedures if you choose to let him help you. In my opinion, I would let him help you get the head of hair you deserve. However, you can certainly consult with other leading physicians for their professional opinions. Second and even third opinions are never a bad idea.

 

I wish you all the best,

 

Bill

[wb280]

topcat, i just went thru your blog. oh my, how did u manage to go thru all those?

 

I feel for u mate, wish only the best for u

[Topcat611]

wb280, I'm not alone, there are hundreds and hundreds of patients who find themselves in similar or worse situations. The fact is it still goes on today, where patients are getting subpar or disfiguring results, and many times it's by the doctors that are promoted the most. I know because I make a point to speak to as many patients as possible on a continual basis.

 

These same patients tend to become desperate and jump into that next procedure in hopes of make a bad situation better. It's just a natural reaction.

 

My advice to MrNik is to take the time to find out who the best in the world is at ht surgery. Obviously everyone cant' be the best. In my opinion there are maybe 2-3 that have the skill, experience, natural talent and ethics. It's a very hard combination to come by.

 

I think MrNik should do a very small fue session 500 or less and monitor the results. It's a safe and sensible approach with very little potential for any harm being done. And this is what a doctor with good ethics would do in a case like this. He would do not harm.

[wb280]

top cat, i understand where u r coming from, but the truth is, we rely very heavily on forums to understand the procedures and to share information and experiences. I agree it might not be the safest, and this is where discretion kicks in. There is a forum which deletes threads for purposes only known to them and nobody should derive their HT decisions based on advice given by these so called veterans. IMHO, this forum has been very fair and does not attempt to hide bad results. However, more often than not, the issues have been blown out of proportion by some. Its a delicate issue and i admit its not easy to settle hence controversies arise.

 

Thats why for patients who have yet to take the plunge, its imperative that they research as much as possible. I mean, a doc who has hundreds of patients vouching for them ( with pics of cos ) has a much lower chance of giving that bad result.

 

My point is, u have a valid stand my friend but in reality sometimes its just difficult to achieve.

[Dr. Mohammad Humayun Mohma]

Dear NK

 

I think I have already asked you to come to the clinic and i will try to solve your problem.

I understand your results are less than optimal. but this is where I stand beside you.

 

Come to the clinic.

 

Regards

[Dr. Mohammad Humayun Mohma]

we do offer FUE but you need to understand that there are quiet a few questions in FUE. I delivered papers on FUE way back in 2003 in ISHRS annual meeting in NY. so that means I was doing FUE even before that. so why should I not do FUE or be very enthusiastic about it?

the answer lies in the arguments below

 

1) every doctor have to go beyond the limits of true donor area to harvest FUE, the question arise knowing that these follicles will shed early as soon as baldness progress, is it ethical to do the same procedure then?

 

2) People say FUE is less invasive. My argument is when I am doing a strip harvest, i see the bottom end of the follicle and stop there. where as in FUE as it is a blind procedure i go a bit beyond the limit of follicle to release the tissue. so in real terms its more invasive than open strip harvest.

 

3) People promote it as scar less, i want to know which doctor in the world call it as a scar less.

in strip harvest, you have 25 cm long 1 mm wide strip in most of tricophytic closure technique. with 2500 grafts. now lets imagine we are doing 0.9mm punch FUE and 2500 grafts. means 2500 x 0.9 mm scars and if we want to calculate the circumference of these scar multiply it with 2 phy r. it will be 141.42 cm. about 116 cm longer than the strip harvest.

 

YES, i agree there is almost no pain post op.

 

is that the only reason.

 

I think, it gets that much of publicity because it gives a surgeon more money per graft to take home then strip harvest.

 

Doctor say in FUE he has the liberty to choose the triple hair grafts, have they ever calculated how many triple hair grafts have partial transactions means one hair transacted among three. means 33% damage... so can some one tell what is the true transaction rate in FUE......

 

you see, as a Doctor, i have to be very unbiased to tell the options of hair restorations to a potential clients. There is one person who came to Pakistan to pay me 12000 $ for a 4000 grafts FUE, i told him all this and he ended up paying 5000$ for same number of grafts.

 

You ask my honest opinion about the value for money, tricophytic scar closure properly done give you less graft and value for money.

 

Having said this , I am still doing FUE with motorised instruments.

 

You people also need to know, i need lesser number of staff for FUE and more money. so economics are on my side if i use FUE rather than strip.

 

now tell me what do you people say

[wb280]

Nicely said Dr Mohmand but there are a few die hard forum members ready to challenge u even with some illogical reasonings. I think u made a few very good points which even the hardcore FUE supporters cannot find fault with. However, I will not be surprised to see a few well known individuals challenging your points though.

[Topcat611]

A doctor who is ethical and concerned about the patient would not go beyond the true donor area to harvest fue grafts. To even make such a statement is a red flag and should be cause for concern.

 

If time is money, common sense would tell you that strip is more profitable. FUE is time intensive and if it is an ethical clinic the doctor will be performing the extractions as opposed to the technicians.

 

Having been around this industry for over 25 years and the experience of actually being in the chair and having multiple procedures including strip, lifts, reductions and fue. I would definitely say fue is the least invasive. Within a few days it was barely evident that I had a procedure performed, both visibly and physically. The numbness and loss of sensation to the back of my head from previous strips lasted well over 10 years if that is any indication.

 

A highly skilled fue doctor knows exactly how deep they need to go when extracting a fue. They have that sensitive touch which the procedure requires. I agree not all doctors are gifted in this area no different than some of the unnatural hairline work we often see. It’s like the artist who has never picked up a brush before, but can paint a masterpiece. Just because a doctor has been trained does not mean he/she is gifted.

 

I think when a patient or prospective patient is referring to scarless they are referring to visible scars. All my strip scars are clearly visible. My fue procedure left no visible scarring including the 200 I had extracted from my face. Once again the skill of the doctor comes into play here and it requires the use of tools that are much smaller than the .9 mm you have suggested.

 

Progress moves very slowly when there are competing interests. We see plenty of strip clinics that are adopting fue. Let's just hope and pray that they become better in time. Some have even switched over to exclusively fue. I have yet to see the opposite happen where a fue clinic switched over to strictly strip.

Edited October 2, 2010 by Topcat611

[Dr. Mohammad Humayun Mohma]

there is a difference between being least invasive and quickest to heal.

I agree that the scars are least visible.

if we use 200 FUE and then talk about 3000 its a lot of difference. I also know that people are using 0.7 mm and some using 0.5mm.

Now i might not be very skilled but i fail to understand the physical dynamics of a three hair unit can actually be accommodated in a 0.5 or for that matter 0.7 mm punch.

The feeling of going deep is no doubt is there but most of the punch will go about 5 to 6 mm deep. and most of the follicle is about 4 mm to 5 mm.

its simple procedure that you need to go deeper than the follicle bulb to make it release it without damage or having the problem we call the decapping.

now with latest motorized versions of equipment the vibration of the machine does not allow you to feel that give that you were mentioning.

I do it and i know how it feels. fair enough i do not do a large volume.

regarding the economics

in FUE, you spend 5 to 6 hours of surgeon time as FUE should only be extracted by surgeon. then it is transplanted by maximum of 2 tech. the price difference is 3 times minimum. the expenses of procedure is almost half including the number of blades needed to prep the grafts, the extra staff.

so all in all you safe more. if not with other doctors in my practice I safe more with FUE then strip even if i do 4 strips in a day as oppose to 1 FUE in a day. this is statistics of my clinic, i might be then different.

 

most of the doctors who are in FUE are actually going above and below the true donor area, simple fact is, the true donor area will fetch you about 6000 follicles that can be done in strip.

if you do FUE, you take 1 in 4 follicles to maintain the minimum donor density to look natural. so if you do that you cannot take more than 2000 grafts. but then there are people doing more than 4000 FUE. now i am talking about type 4 and above MPB.

ofcourse if you doing it for type III or so, then the question arise on the future of hair loss...........

the true donor area in most cases cannot spare more than 7000 grafts in a person who can potentially go more than type V to VI MPB. YES in few individuals it can.

 

i am sure it will get better with time. there is a doctor who thinks he take a small core out of a follicle without damaging the follicle and hence he claims he is doing a cell multiplication/cloning.

I respect him but i am very sceptical of him. i have not seen a great improvement in his pre and post operating results.

 

i am just sharing my thoughts as a surgeon. I might be not correct but this is what i believe.

[Dr. Mohammad Humayun Mohma]

dont take me wrong in way that i am against the FUE procedure. I am just cautious about using it.

its a great procedure especially with motorized versions.

Much less fatigue, easy to harvest, less trauma, and less collateral damage.

[Blake Bloxham]

Thank you for sharing your input Dr. Mohmand.

[Megatron]

Excellent posts by Dr. Mohmand. Thanks for that valuable insight into FUE.

[Julius]

Great post thank you Dr. Mohammad

[Topcat611]

Dr. Mohmand, thank you for posting. You seem to be very civil which I would say makes for a great doctor. I have seen too many doctors in this business take the authority stance too far, which I believe is not good for the patient.

 

 

I would still have to disagree with you. As far as the economics are concerned if you can do 4 strip patients in one day at an average of 3000 grafts, costing $4/graft you would have a total of $48,000 for the day. If we look at taking a fue patient with 3000, we are probably talking about working on just that patient all day if not a second day. At $6/fue you have a total of $18,000. This leaves a balance of about $30,000. It’s very hard for me to believe that this does not cover the cost of the extra staff and other necessities without leaving more profit for the day. So of course it’s best economically to do strip as opposed to fue, but what is best for the patient?

 

You also have the learning curve. How long does it take someone to become highly skilled? This adds to the cost. One has to consider the reality of many doctors not being able to become highly skilled, so of course they will be forced to offer only strip.

 

 

You made the statement that it will get better with time, referring to fue. It has gotten better, but there are less than a handful of doctors one can say this about.

 

These are just my opinions from what I have seen over the years and I am always open to new ideas.

Edited October 10, 2010 by Topcat611

[Sean]

Thanks for the information and explanation Dr. Mohmand. Very interesting stuff here regarding FUE and Strip.

[tarepanda]

Mr NK

 

u got any updates??

r u seeing more growth now?

 

hope everything turn out well for you!

[wb280]

tarepanda, i was also hoping MR NK would update but alas, like so many others, they had problems and vanished into thin air without a trace of what happened in the end. I am still hoping NK's case would not end up like that, i am still hopeful

[Mr.Nk]

Hey everyone !!

 

yeah i did vanished fer few months and was not posting but actually i was waiting for a year to complete !!

 

well now 13 months have been completed and ill be taking new pics today and then lets see if there are any changes !!

[Sean]

Can't wait to see your results Mr. Nk.

[Tonycc]

Good luck... looks like Dr. Mohmand is handling this well. I wish you the best.

[TakingThePlunge]

Mr. NK,

 

Welcome back! I am looking forward to your photo update.

 

All the best,

[wb280]

Mr NK!!! Glad to see u back here!!! Please post pics!