Sugar Goes to Ottawa - My 2822 FUE with Dr. Rahal

[stinger99]

he sugar, i echoe agenteye's comment. i m seriously considering fue with dr rahal and cant wait to see your update<

[cargo65]

Mickey85. Its useless for him to write anything as Dr. Rahal is no longer a recommended doctor here plus he may reached a deal from Rahal in order to keep it low. Just forget about sugar and Sean and focus on your future session scar and hairline revision with Dr. Feriduni this January.

 

 

Wait.

 

Not a fan of Rahal anymore HARIRI? At best, you toned your comment in an unfortunate fashion. At worst, is sounds like you may have an axe to grind.

 

 

 

Not being recommended is vastly different than not being able to post due to local Ottawa law.

[savehair]

Hi Sugar High,

 

any updates? also interested in going through FUE with Dr. Rahal but just wanted to see what was the latest update, can you let us know or pm me?

 

thanks!

[SugarHighs]

Hey Guys,

 

So I met with Dr. Rahal in mid September to discuss my FUE case. He was in California for something and I was really happy that he took time to meet me.

 

When we first met, he wasn't sure it was me - in other words he found the result to be better than expected, however upon close examination, he also agreed that the 8th month result was not ideal.

 

I tried to get an understanding how my hair could have grown well initially through 5 months, and then began a shed, but Dr Rahal said that once the hair grows, that means the follicle survived and future shedding should be unrelated to the procedure. I mentioned that a few other FUE patients had had the same issues, and he he said he would ask if any other doctors had seen issues such as mine.

 

I pointed out a few spot, especially on the right side, where hair didn't grow, or grew poorly. This is the side where I had an ingrown hair, and some swelling at month 3, so Dr Rahal said that might be a factor.

 

Long story short, the shedding in the recipient area hasn't slowed down complete, although I have had some definite maturing in certain areas. The left side seems to have grown better than the right, and matured better, now at 11.5 months. Thankfully, Dr Rahal was extremely confident that he can address the thinner areas, and will be seeing me again next month for a touch up of ~900 (yet to be determined) grafts.

 

I should note that, while I am not wealthy, I do have the resources currently to go to any doctor of my choosing, however I have decided I trust Dr Rahal to do my FUE touch up. \

 

I will provide further updates as time goes on.

 

Thanks,

Sugar

[SugarHighs]

Hey Guys,

 

So I met with Dr. Rahal in mid September to discuss my FUE case. He was in California for something and I was really happy that he took time to meet me.

 

When we first met, he wasn't sure it was me - in other words he found the result to be better than expected, however upon close examination, he also agreed that the 8th month result was not ideal.

 

I tried to get an understanding how my hair could have grown well initially through 5 months, and then began a shed, but Dr Rahal said that once the hair grows, that means the follicle survived and future shedding should be unrelated to the procedure. I mentioned that a few other FUE patients had had the same issues, and he he said he would ask if any other doctors had seen issues such as mine.

 

I pointed out a few spots, especially on the right side, where hair didn't grow, or grew poorly. This is the side where I had an ingrown hair, and some swelling at month 3, so Dr Rahal said that might be a factor.

 

Long story short, the shedding in the recipient area still has not slowed down completely, although I have had some definite maturing in certain areas. The left side seems to have grown better than the right, and matured better, now at 11.5 months.

 

Thankfully, Dr Rahal is extremely confident that he can address the thinner areas, and will be seeing me again next month for a touch-up of ~900 (yet to be determined) grafts.

 

I should note that, while I am not Bill Gates, I do have the resources currently to go to any doctor of my choosing- however I have decided I trust Dr Rahal to do my FUE touch up.

 

I will provide further updates as time goes on.

 

Thanks,

Sugar

[Davis91]

Good of you to check in Sugar.

[TakingThePlunge]

SugarHighs,

 

Thanks for posting your update! I'm happy to hear that you met with Dr. Rahal and have opted to proceed with a follow up with him. I have every confidence in his skill and I'm sure you will ultimately get the results you are hoping for.

[Gandolf]

If you don't mind me asking is your follow up procedure regular price, discounted, or no charge? Regardless, it sounds like Dr. Rahal cares very much about his patients and is going to extra mile for you to make sure you're happy with your final result, I think you're making the right choice to go back to him. And thanks again for sharing your experience with the group!

[Davis91]

Sugar, did you ask whether the dense packing of thicker curlier grafts could have affected yield?

[SugarHighs]

No one in the "hair" community has been able to provide an explanation yet.

 

I would say hair thicker than mine has been packed more densely and grown well, so I don't know if that's the answer.

[spile]

No one in the "hair" community has been able to provide an explanation yet.

 

I would say hair thicker than mine has been packed more densely and grown well, so I don't know if that's the answer.

 

Hey Sugar, I've had 2 failed HT's from Rahal also. Who was your lead technician? Both times mine was Mike. I'm still trying to figure out what went wrong and thought we could compare notes. A failed HT is so stressful. There isn't a day that goes by where I don't think about it!

[Slickers]

Hey Sugar, I've had 2 failed HT's from Rahal also. Who was your lead technician? Both times mine was Mike. I'm still trying to figure out what went wrong and thought we could compare notes. A failed HT is so stressful. There isn't a day that goes by where I don't think about it!

 

Spile, do you have any pics? Was it FUE or FUT?

[splitting hairs]

There's no question that Dr Rahal is one of the worlds best, however if you research well you will see that generally FUE surgeons advise against so called FUE mega sessions.

 

The reason is due to the yield with FUE being lower that FUT, also certain patients follicles may be more sensitive to the damage and transaction caused during a FUE procedure, which can lower the yield further. Physician fatigue with large numbers of extractions plays a part in yields to, since FUE is highly labour intensive, hence the high cost.

 

The reality is that FUE has been touted for years as a wonder procedure. In reality, it should only be used for minor work up to 1500 grafts IMO, I know this is what Dr Feller preaches.

 

So, if you need a large number of grafts, or are likely to in the future due to your family history. FUT is the way to go.

 

You just have to look at how skilled Dr Armani was with FUT, then he started doing FUE mega sessions and his Yields were ridiculous.

[Mickey85]

There's no question that Dr Rahal is one of the worlds best, however if you research well you will see that generally FUE surgeons advise against so called FUE mega sessions.

 

The reason is due to the yield with FUE being lower that FUT, also certain patients follicles may be more sensitive to the damage and transaction caused during a FUE procedure, which can lower the yield further. Physician fatigue with large numbers of extractions plays a part in yields to, since FUE is highly labour intensive, hence the high cost.

 

The reality is that FUE has been touted for years as a wonder procedure. In reality, it should only be used for minor work up to 1500 grafts IMO, I know this is what Dr Feller preaches.

 

So, if you need a large number of grafts, or are likely to in the future due to your family history. FUT is the way to go.

 

You just have to look at how skilled Dr Armani was with FUT, then he started doing FUE mega sessions and his Yields were ridiculous.

 

Please....

 

There are foreign forums that are basically all 90% FUE results with many upward of 1,500 grafts and the results are almost as consistent as FUT. Doctors like Lorenzo, Mwamba, Feriduni, Bisanga, Umar, Erdogan and De Reys have shown that FUE is not merely for small cases. I don't see those physicians complaining about fatigue. So because one Doctor here 'preaches' FUE is only for small sessions does that make it gospel? So because one unethical Doctor(Armani) who was known for scamming his own patients(by exaggerating the graft count) and dense packing 25 year olds back to nw0 got bad yield with FUE does that discount the whole method? Fault the surgeon not the method.

 

FUE does away with many of the drawbacks of FUT that are not brought up by FUT-dominant clinics because they get better results from FUT. They haven't put the time into FUE to improve their technique so the discount it and minimize it's potential. They will tell you your FUT scar will not be noticeable but won't tell you about the potential to stretch, potential permanent numbness, tingling and/or headaches. The benefits of FUE included:

 

No linear scar FACT

Less invasive FACT

Ability to cherry pick hairs of different groupings/caliber and to the exact quantity FACT

Ability to wear hair much shorter to a grade 1 or 2 FACT

Doesn't destroy the natural swirls/growth pattern/direction of hair of the donor area FACT

No potential scar stretch FACT

 

What are the benefits of FUT? Better yield? At what cost? How much better is the yield? No Doctor can guarantee the FUT scar will end up pencil thin. No doctor can guarantee good yield with FUE. Oh wait, they don't guarantee that with FUT either!. The notion that FUE is only for small cases or minor recession is ridiculous.

[splitting hairs]

If u think FUE is superior to FUT in every way you are sadly mistaken.

 

Read this article by Shapiro medical group on the benefits and limitations of FUE:

Follicular Unit Extraction (FUE)

 

Note that they say that you may only be able to obtain HALF the grafts from FUE as you can from strip as the donor may become noticeably thinner otherwise.

 

In addition:

 

DISADVANTAGES

• Maximum graft yield, if used exclusively, is lower that with FUT (due to the inability to harvest all the hair from the mid-permanent zone)

• Distortion from initial FUE makes subsequent FUE difficult

• Greater potential for follicular transaction (damage) than FUT

• Grafts harvested outside the permanent area may be lost in future

• Potential for spotty scarring in the donor area after a larger number of grafts have been harvested

• Takes longer and is therefore more expensive

• Grafts are finer with less tissue protection and therefore more susceptible to trauma, and there is a potential for less yield

• Capping or buried grafts may occur with certain techniques

• So much attention and time is given to the donor area that the recipient area sometimes does not get the attention it deserves

 

The reality is that both procedures DO have their place in treating hair loss, but FUE is IMO sold as having no disadvantages.

[Mickey85]

If u think FUE is superior to FUT in every way you are sadly mistaken.

 

Read this article by Shapiro medical group on the benefits and limitations of FUE:

Follicular Unit Extraction (FUE)

 

Note that they say that you may only be able to obtain HALF the grafts from FUE as you can from strip as the donor may become noticeably thinner otherwise.

 

In addition:

 

DISADVANTAGES

• Maximum graft yield, if used exclusively, is lower that with FUT (due to the inability to harvest all the hair from the mid-permanent zone) True in most cases

• Distortion from initial FUE makes subsequent FUE difficult Lorenzo/Erdogan/Umar/Mwamba/De Reys/Bisanga/Feriduni don't think so. Also subsequent FUT sessions are more difficult due to less laxity.

• Greater potential for follicular transaction (damage) than FUT Indeed but let's not forget the potential grafts that can be lost whilst making the incision for the strip and tech transection of grafts. FUT is not flawless in perfect graft preservation

• Grafts harvested outside the permanent area may be lost in future Easily avoided, in fact I have seen strip clinics go outside the safe zone too. Point is moot

• Potential for spotty scarring in the donor area after a larger number of grafts have been harvested And yet still less detectable than a linear scar

• Takes longer and is therefore more expensive So going on the cheap is better?

• Grafts are finer with less tissue protection and therefore more susceptible to trauma, and there is a potential for less yield Valid

• Capping or buried grafts may occur with certain techniques True but can be avoided

• So much attention and time is given to the donor area that the recipient area sometimes does not get the attention it deserves Circumstantial

 

The reality is that both procedures DO have their place in treating hair loss, but FUE is IMO sold as having no disadvantages.

 

I wrote my counter arguements in your quote in bold.

 

I never said FUE was superior to FUT in every way champ. I just said it was superior to FUT and does away with many of the drawbacks found in FUT. Lorenzo has shown us that large numbers CAN be extracted and the donor still shows less evidence of surgery compared to FUT. That "Half" rule is hearsay and circumstantial based on each patient. To generalize and make a rule out of it is not correct. FUE does have disadvantages but only in yield and the total amount that can be taken compared to FUT in general. Even these factors have been exaggerated and made worse than they seem.

 

How about the grafts that are lost in the strip due to being in the telegen(spelling) phase? Roughly 10% of all hair is resting at any given time and this resting hairs cannot be seen even via microscope so they are discarded. Do Shapiro mention that? Does Feller mention that? A whopping 10% not to mention any hairs transected due to the scalpel running through the follicles and tech error.

Edited February 2, 2013 by Mickey85

[chrisdav]

Mickey,

 

You did mention recently that you were depressed from the strip scar you received from your initial surgery. I would say it is evident in your posting and I fully understand why you are like that. You are not the only one though as I have seen it across other forums.

 

However thinking rationally over emotionally is imperative. Both procedures have their positives and negatives.

 

Two of the surgeons you have listed that perform both procedures, giving a less bias view towards one procedure or the other, in Dr Feriduni and Dr Bisanga, who even themselves do not feel FUE is a superior procedure by any length.

 

I enclosed a copy of what the representive of Dr Bisanga had to say regarding FUE underneath:

 

 

 

We have posted a great deal on FUE in the past, harvesting and extraction protocols, what makes a good and bad candidate, and the technicalities of the actual technique, manual punch advantages and having a great knowledge of anatomy.

 

Almost all the people that contact us for advice, from NW2 to NW7 men and almost all ask for FUE; largely due obviously that FUE is perceived as non-scarring (an untruth) and can give advantages such as shorter hair cut styles and no linear scar.

 

Obviously I have had FUE and started before restoration as a NW5/6 and have be privileged to be able to achieve a good coverage from hair line to crown solely with scalp and BH FUE with now over 8000 grafts. But I was fortunate in that my starting donor density was well above average around my donor, averaging over 100 FUcm2 and my general hair characteristics have helped a great deal, in short I was/am not a typical FUE candidate.

 

In some respects calculating FUE suitability is relatively simple, donor hair density and characteristics verses hair loss pattern, also evaluating potential for future loss and patient expectations short and long term. FUE does not change the surface area of the donor, what changes is the amount of hair left in the donor, the more hair removed leaves the donor area with less hair so there is going to be a limit to the amount of hair that can be removed and the higher the level of starting hair loss may rule some out from being good FUE candidates.

 

If we take some measurements of the safe donor, say 30cm from one side to the other and a height of 6cm on average and a starting average density of 75FUcm2, within this area we have around 13,500 FU. Then the amount that can be removed without over harvesting, not leave patchy areas of low density, not harm the surrounding hair and give options for the future, this % is around 25-30%, so if we look positively on the above numbers we could remove around 4000 FU.

 

4000 FU will not give someone total restoration if they are NW4 possibly and certainly above it may not be able to treat the person's goals and expectations. Those with a lower NW scale maybe good short term candidates being able to replace a hair line, frontal third and slightly into the mid-section but future hair loss may not be able to be treated with FUE alone, and this is important to appreciate before starting off as if Strip/FUT is totally out of the question then a long look should be taken before starting on the hair transplant road.

 

When you set your mind up on having FUE and the benefits it can give the last thing you want to be told is you may not be a suitable candidate. As a clinic that offers both techniques we always look to offer what we feel is best for the patient, not having a preferable technique we can transparently assess without bias one over the other.

FUE may be able to use initially if the hair loss pattern allows but because of the technique’s limitations in FU numbers over one or multiple procedures compared to Strip. Unless the donor has a starting density way higher than the average and FUE is preferred, if the pattern of loss has already progressed or whether it will obviously progress then aspects such as hair line design have to be considered to ensure a balanced looking head of hair, also accepting that there will be limits to the coverage able to be achieved, either in one or multiple procedures with FUE.

 

Can a greater number be taken with FUE? Obviously yes but it could mean over harvesting in the donor reducing the number of grafts that could be punched long term, increase transection and possibly visible scarring. With FUE it is better to sometimes go slow and with lower numbers to preserve the integrity of the donor.

 

An average donor will harvest in one procedure more FU with Strip than FUE, with FUE it has been shown that the more punched in one session can be detrimental to the yield and the donor healing, each clinic may have their own opinion as to the number, we suggest around a maximum of 3000 over 2 consecutive days. Strip with same density would be able to reach higher numbers in a first procedure therefore giving more leeway in hair line design and better coverage on higher NW scale hair loss sufferers.

 

A hair transplant is a big decision, one of the biggest we make in our life and it is important to have a good understanding of the pros and cons to each technique, and can actually be combined to maximise the grafts numbers and with FUE now it has opened the donor to widening the donor area, so patients with previous Strip scars have now another option. People have their opinions as to what is best and it is vital that all the options are understood, not just now but for the future, gather opinions from various doctors and meet old patients when possible, and take your time to make up your own mind.

[Mickey85]

Thanks for that Chrisdav. You are right that Feriduni and Bisanga do not think FUE is superior, but I never said that. I only said that they perform subsequent and megasession FUE. I do acknowledge that FUT can yield a greater amount than FUE, I even said "FUE does have disadvantages but only in yield and the total amount that can be taken compared to FUT in general" so I'm not sure what your quote is trying to imply. I never said FUE was ideal for higher NW ratings either or that FUT was totally obsolete. A NW5 or more would most likely not have enough grafts via FUE alone to achieve a decent result sadly.

 

I still stand by my points. Maybe I am thinking irrationally, but please, point out where my statements have been irrational? Are any of my counter arguments in bold incorrect? It's there in black and white, regardless or rationale or emotion. Simple because I am pro-FUE does not render any of my arguments automatically incorrect. Point out where I am wrong, I won't mind, I like having civil discussions.

 

I have acknowledged that FUE is not flawless and has flaws in potential yield and total amount that can be taken. Those are the only flaws I see with it but other than that I see it as being a totally superior method. All the aforementioned Doctors(sans Feriduni and Bisanga) have left FUT and gone to FUE. They all practiced FUT and have left it behind. Why would they leave it behind if the results of FUE were significantly worse than FUT? Surely the increased income would eventually be offset by upset patients and bad word of mouth so I do not think it is purely a monetary move.

[SugarHighs]

Hey Sugar, I've had 2 failed HT's from Rahal also. Who was your lead technician? Both times mine was Mike. I'm still trying to figure out what went wrong and thought we could compare notes. A failed HT is so stressful. There isn't a day that goes by where I don't think about it!

 

Hi Spile,

 

I'll be happy to discuss it with you once you've posted / mailed me before and after photos from your procedures, as I have done here in my thread.

 

As it stands, I do not know what your meaning of "failed" is, as pertains to your HTs.

 

I personally would not yet use the word "fail" in my case, because in spite of some shedding, and some areas where growth was not optimal, I did have some very good growth. More importantly, I have a very natural hairline. When I look at "before" photos of myself, and then I look at myself in the mirror now 13 months post, I do not recognize the person in the before pics.

[SugarHighs]

Mickey, Splitting, Chris,

 

There is no doubt that, in general, FUT has produced better and more consistent growth on a whole than FUE. No person who is remotely educated about HTs would argue this point.

 

That said, which is "better" is highly subjective. I personally opted for FUE because I have been told throughout my life that I am very good-looking with very short hair/a shaved head. So in the worst case scenario (knock on wood/pray to God) I will still look good.

 

For this reason I opted against a strip scar, which one can never really get rid of. For someone with different priorities, he may opt for FUT. It's extremely subjective, and arguments about which is the "superior" are ultimately futile. In any case, if folks would like to continue this discussion, I hope they'll take it to another thread.

 

Thanks,

Sugar

[Mickey85]

Sorry for going off topic champ.

[SugarHighs]

Thanks, man, you're a great contributor here.

[spile]

Hi Spile,

 

I'll be happy to discuss it with you once you've posted / mailed me before and after photos from your procedures, as I have done here in my thread.

 

As it stands, I do not know what your meaning of "failed" is, as pertains to your HTs.

 

I personally would not yet use the word "fail" in my case, because in spite of some shedding, and some areas where growth was not optimal, I did have some very good growth. More importantly, I have a very natural hairline. When I look at "before" photos of myself, and then I look at myself in the mirror now 13 months post, I do not recognize the person in the before pics.

 

I guess my case is different than yours as my grafts never grew. Here are some before and after photos, 2617FUT not FUE though. I was looking at this post http://www.hairrestorationnetwork.com/eve/164123-hair-transplant-w-dr-wong-morning-3.html and had many of these "J" remnants that could be plucked out or removed by hand several months later with no bulb attached. Maybe these grafts were pushed in too deep and damaged the follicles?

 

Anyhow I'll PM you. Don't mean to hijack your thread.

Edited February 5, 2013 by spile
Doctor requested that I remove the pics and work it out with him

[Mickey85]

Thanks, man, you're a great contributor here.

 

Thank you Sugar, your appraisal means alot to me. I wish you all the very best on your subsequent FUE procedure with Rahal.

[stinger99]

what has dr rahal said about the failed result? why did it happen. you had 2600+ grafts in a small area, your results should be much thicker and fuller than what the pics above are showing.