Best FUE Drs for advanced balding 5-6

[Blake Bloxham]

OMG, this, IMHO, is diabolical. But that is because I cannot handle a balding crown and thick hair behind it. Maybe just me. To me I think..

 

A Norwood 6 - a massive strip??

 

Bad move. (unless over 60 yrs old??)

 

Slow and modest FUE is the way to go for a NW6. (and then SMP)

There is a good case for a NW6 from Hasson and Wong going around the forums now, and he is not happy. Check it out. And with the massive scar you will have, what will be your options? You will have to grow out the back no matter what. Never mind people saying they can 3# guard the back. The illusion of volume needs length at the front fro it to work!! So you need hair at the back to both cover the scar as well as balance the picture. Result = bald crown. Try buzzing = no illusion, scar? Trap. See what I mean. Modest FUE with SMP a better option fro most. But as I say. If you dig a bald crown, strip is the way for a NW6.

 

FUE for a Norwood VI? I don't think you're going to find a lot of support from leading clinics, even with the addition of SMP.

 

In my opinion, is slow FUE + SMP on a large Norwood case a bad treatment plan? No.

 

It could lead to some safe, conservative results, but it's also a long road and involves two tricky variables: FUE on a huge case and depending on a fairly new and unproven treatment to pick up the slack. What's more, I'd argue that very thin coverage and harsh SMP on a NW VI could be just as much of a physical detriment as a FUT scar.

 

Like you said before, it will come down to personal goals; hair transplantation often does. However, I think that the "standard" of treatment for high NW cases, as of now, would likely still be a FUT megasession.

 

Just for some perspective:

 

Here is the first megasession FUT case for a NW VI patient I stumbled upon on Hasson & Wong's website (you mentioned the clinic earlier so I utilized their results as an example of FUT on a NW VI): Hasson & Wong, FUT on NW VI

 

For comparisons sake, I recommend doing a google search and looking at some of the SMP high Norwood cases. While SMP can be great and I look forward to its ongoing evolution, I don't think the results with progressive FUE match the above.

 

Again, it comes down to patient preference. As long as individuals are conducting thorough research and maintaining realistic expectations, differing hair restoration plans work.

[scar5]

FUE for a Norwood VI?

 

I don't think you're going to find a lot of support from leading clinics, even with the addition of SMP.

 

Here is the first megasession FUT case for a NW VI patient I stumbled upon on Hasson & Wong's website....

 

For comparisons sake, I recommend doing a google.....

 

Again, it comes down to patient preference.

 

Future and readers.

 

The four points above are addressed...

 

1) Of course I won't find a lot of support from 'leading clinics'...what does that mean? I plea u to explain ti readers the reasons why u won't find a lot of support today, August 8, 2012 among our finest clinics for such a plan, nor will u find a consistent track record showing great results. Tell the Olympic runners to hold back!

 

2). Now tell the folks the recent poster from Dr Wong who was really bald and had a big strip and looks poor. Yo know the one! I am not dissing h and w and I have the highest respect fr them, but please donT give me that kind of treatment.

 

3) How can I possibly find big SMP And slow and steady FUE now, in 2012, knowing we are talking about a five to ten year plan, and SMp has been around for about two weeks!

 

4) Patient preference. The patient is asking us! Heck!

 

...see how hard it is to post boys and girls!

[Mickey85]

Who is the recent poster from H&W who was not happy with their procedure??

[Bill - Seemiller]

Scar,

 

In my opinion, FUE is a viable procedure for many patients but most leading surgeons to date still recommend FUE for patients with lesser areas of balding. Some however, do feel that FUE is the way to go for all patients.

 

Given that you are dissatisfied with your past FUT, I can understand why you are a proponent of FUE over FUT. But patients also have a right to know about viable opinions that differ from yours.

 

I'm not sure why you say it's difficult to post. You are welcome to share your opinion. The only reason why Blake is engaging you is because you jumped on him for giving viable advice that differs from yours. Note your response directly to Blake "OMG, this, IMHO, is diabolical."

 

Both you and Blake are entitled to your opinions and I trust that those considering their own path can draw their own conclusions based on everything they're reading.

 

Best wishes,

 

Bill

[Bill - Seemiller]

By the way, I am a former Norwood 5A/6 and have successfully restored my hair via several FUT/strip procedures. Those who would like to learn more about my experience and view my detailed photos can click on the links in my signature :-).

[Blake Bloxham]

Scar,

 

Before I really post anything, I just wanted to clarify a few things:

 

first, I wrote my last reply with no intention of malice or negativity. If it came across as me trying to argue, aggressively prove my point, or simply "bully," it was a mistake and I apologize.

 

Second, I really have no hidden agenda here. Frankly, I think a quick review of my posting history will demonstrate that I'm very open to new and evolving hair restoration treatments, and my only goal on the forums is educating patients in the most trusted, ethical hair restoration techniques.

 

Third, as I stated earlier, hair restoration plans are very patient specific. If the original poster wants an FUE procedure for a NW 6 balding pattern because he personally believes reduced donor scarring and the potential for completely shaving the head is more important than density or extracting more grafts with less transection in a single session - that's perfectly fine. As long as patients complete sound research, I have absolutely no qualms.

 

However, as I stated earlier, part of my role on the forums is helping patients complete this research, and it would be unethical of me to fully endorse anything besides the "gold standard." If a patient states that they understand the potential limitations of a "FUE + SMP" procedure and simply desires information, I will happily oblige. However, if a patient asks: "what is better for a NW 6 pattern - FUE + SMP or FUT megasession?" I will still likely recommend FUT.

 

 

Future and readers.

 

The four points above are addressed...

 

1) Of course I won't find a lot of support from 'leading clinics'...what does that mean? I plea u to explain ti readers the reasons why u won't find a lot of support today, August 8, 2012 among our finest clinics for such a plan, nor will u find a consistent track record showing great results. Tell the Olympic runners to hold back!

 

This statement confuses me. By leading clinics, I mean state-of-the-art, ethical, up-to-date hair transplantation practices. Are you stating that these clinics have an ulterior motive? I don't think I can explain it to our readers any clearer than that.

 

2). Now tell the folks the recent poster from Dr Wong who was really bald and had a big strip and looks poor. Yo know the one! I am not dissing h and w and I have the highest respect fr them, but please donT give me that kind of treatment.

 

Actually, I 100% don't know "the one." Literally, when you brought up Hasson & Wong, I went to their website, clicked on the "NW 6" section, and pulled the first patient I saw. I wasn't trying to "cherry pick" results, and I legitimately don't know what patient you're talking about. However, I do feel confidently stating that no clinic has a perfect record, and I'm sure you could find more dissatisfaction with patients undergoing less proven procedures for high balding patterns. What's more, if you'd like to share the case with me, feel free to send a private message.

 

3) How can I possibly find big SMP And slow and steady FUE now, in 2012, knowing we are talking about a five to ten year plan, and SMp has been around for about two weeks!

 

Frankly, if you can't find proven results, I think it's very difficult to recommend it to patients as a solid alternative. What's more, I don't think it's impossible to find a NW VI FUE case and imagine how SMP could augment. Furthermore, did the patient state that he wanted to restore his hair slowly over a decade? This seems like something most patients aren't requesting.

 

4) Patient preference. The patient is asking us! Heck!

 

True; which is why I stated multiple times that if the patient is set on FUE, I will provide the best advice possible. However, I don't think it's fair to discuss hair restoration on a NW VI and not at least recommend researching a FUT megasession.

 

Hope this clarifies a bit!

[scar5]

OK...(as he takes a big breath and chills..)

 

I didn't need to resort to histrionics like 'OMG' and 'unbelievable' or whatever word...

 

 

but just three things for the humble reader..

 

1) Never, ever believe that 'track record' of 'leading clinics' is a yard stick for possibility and optimization in your case. All the great wow results we see, and all the remarkable recoveries from 'the brink' were done by breaking barriers down. Ten years ago, 2500 was a massive strip. FUE was 'a lie'. Proven results are still important, but they do not define the scope of what each and everyone should look at.

 

*Put your hand up if u r on Fin and long term proven results and side effects are something u had to do without when making the initial call to continue with it?

 

2) Never assume that great scar5 doesn't know that all clever posters also know that all the docs, clinics, reps, moderators, 'veterans' etc...on a website have not got their agenda.

 

2) I saw a less than optimal strip result on a pretty bald patient, by an excellent clinic- which just happened to be H&W (our friends and an important sponsor on this site) . I pointed it out, simply that I saw it (not URL) - and u can believe me or think I'm just BS, whatever, I don't care. But FutureHT says, 'hey, I don't know what ur talking about, I went to the H&W gallery and saw this one instead!'

 

I mean , gee, what can I say??? It is like asking Johhny, 'Hey, Johnny, did you steal the candy?' 'Na..look Mom, look, I can ride my bike!"

 

So I got a tad pissed...(American English= got me a little angry!)

 

But I respect HTDoc and like his posts and all..and if I ever had to moderate a site, I could do with a dose of that style to keep the ship on an even keel, etc..

 

 

3) Let me tell ya all what I mean by my strategy for NW6 who doesn't want a bald crown.

 

a) Firstly, a big strip will get u great results up front (sans crown) or a scattered approach which will leave you thin but with hair that if grown very long, can be combed into a 'wall' or veneer of hair that lies across the scalp and in fair whether and generous light can be impressive or at least passable. A bit of concealer and u'll be brilliant! A faux-mohawk and you are ten years younger, twenty!

 

b) The longish front/top will go well with the back which would be anything from a #4 buzz to a long surfer.

 

c) Turn side on, and you will notice a dip in the contour across the crown. Harsh light will illuminate the donut on the crown. Or u'll simply have a hole.

 

d) On the other hand. If you thinned out the HW6 horse shoe at the back, by doing FUE, buzzed it or part of it (say you don't suit a buzzed head - it is still useful to have parts or portions of the areas buzzed to accentuate or disguise other areas) - and placed those hairs along the hairline and across the top, planted acutely flat, and then had SMP in between them, you would have the option to grow as long as you could get away with, or buzz it all off and say damn it - for all your life!

 

e) I'm not saying that (d) is the way to go, but it is an option.

 

It's just my personal opinion that I think a NW doesn't need an ear-to-ear scar to compound his life. No doubt strip is a solid way to go - less risky than FUE, but the scar is a scar. By the way, my scars are almost concealed nowadays, so I'm not crying bitter tears into my pint of bitter. Or perhaps I am, cause it took so long the beer went warm!

 

Now there are few 'track records' to prove my point, simply because of the trend of strip to dominate the HT industry, forums like these, and let's face it, how many bucks would they all make from such an approach? Not many!

[Blake Bloxham]

Hi Scar,

 

I get what you're saying, and I really appreciate you sharing a unique point of view. One of the great things about our discussion forums is the wide array of patients, experiences, and results shared each day. Obviously, some of these experiences and opinions will be less than stellar, and I think we do a good job of letting these voices be heard. What's more, I think our forums appreciate the fact that individuals researching hair restoration can learn from these experiences as well.

 

Having said that, I truly hope you don't think we have some sort of "hidden agenda" or endorse any lesser procedures for financial reasons. I know you don't have to believe me, but I've been on "both sides of the fence" with regard to our community, and I can honestly say that we're extremely patient focused and run an open and honest discussion forum.

 

What's more, I think that the surgeons we do endorse are very innovative and offer a variety of other options besides standard FUT. For example, Dr. Bernstein and Rassman were some of the first physicians to experiment with FUE and actually wrote the original article describing the procedure. Dr. Rassman is also an SMP pioneer. Furthermore, Dr. Umar is a BHT and FUE pioneer and Dr. James Harris was one of the first physicians to create, utilize, and spread an automated FUE device. I could go on and on, but my point is that we recommend very innovative, varied practitioners.

 

Altogether, I'm glad the original poster was able to read this discussion. Hopefully it will give him a more detailed perspective and help him select the best procedure for his hair loss pattern. Again, I personally think this would be a large FUT session, but clearly there are other options and if the individual is set on FUE, we can all help point him in the right direction.

 

Again, I hope this discussion continues and the poster gets the advice/guidance he needs.

 

Scar, if you ever do have any questions about the boards or if I can help clarify any issues with the recommendation process, why we suggest certain treatments, etc, please feel free to send me a private message.

 

Thanks again, guys!

[Spanker]

Right now, I think fut is still the standard for someone wanting a big session in one shot. It is less risky and more reliable. Someday, fue may be the gold standard, but for me, it is still in its beta phase. (Sean is the person I can pull off the top of my head).

 

Cantdecide comes to mind of a big session and a killer fut result. When fue scarring is reduced further, transaction is reduced, and yield truely is solid almost everytime, I will jump on the fue trai full force. There are some ethical docs that will tell you that the best results will come from fut.

 

It is a give and take. If you are willing to risk a little yield and get less desirable grafts for a cleaner donor, fue may be the right choice for you, but it is by no means bullet proof.

[Blake Bloxham]

Right now, I think fut is still the standard for someone wanting a big session in one shot. It is less risky and more reliable. Someday, fue may be the gold standard, but for me, it is still in its beta phase. (Sean is the person I can pull off the top of my head).

 

Cantdecide comes to mind of a big session and a killer fut result. When fue scarring is reduced further, transaction is reduced, and yield truely is solid almost everytime, I will jump on the fue trai full force. There are some ethical docs that will tell you that the best results will come from fut.

 

It is a give and take. If you are willing to risk a little yield and get less desirable grafts for a cleaner donor, fue may be the right choice for you, but it is by no means bullet proof.

 

Great analysis. I think you really got to the core of the issue and touched on the most important aspects of the situation.

[Mickey85]

I personally think that if the patient's donor supply is plentiful, then FUE for a NW5 or NW6 should not be an obstacle. NW7 would be pushing it but that is even the case with FUT. You aren't going to get a juvenile hairline with full 70 grafts per square cm density with either method.

[Levrais]

Right now, I think fut is still the standard for someone wanting a big session in one shot. It is less risky and more reliable. Someday, fue may be the gold standard, but for me, it is still in its beta phase. (Sean is the person I can pull off the top of my head).

 

 

I know that even the top fue docs say that you can get more grafts via strip. However as for reliability I just haven't seen many failed fue at all and no failed fue from the top clinics. Unless I'm just missing them, it seems that the people posting poor results (admittedly very few) have had a strip procedure.

[Spanker]

I know that even the top fue docs say that you can get more grafts via strip. However as for reliability I just haven't seen many failed fue at all and no failed fue from the top clinics. Unless I'm just missing them, it seems that the people posting poor results (admittedly very few) have had a strip procedure.

 

 

If would be really interesting to see some good statistical data that is reliable.

 

Lev, your HT looks great, I can't remember the specifics of your case, but I do remember you had a good result.

 

One problem that I find with FUE results is there are just not a lot out there by users. You are kind of an exception. Also, those "wow" results that people talk about, I have not seen in FUE (that I can think of). You had a great case, but you already had good hair too. I am talking about the big transformations. Unless a clinic puts out really really detailed and good photos, I prefer to go by patient photos.

 

Like I think I mentioned, Sean is an FUE that didn't work out (IMO, he is around 10 months I think), I have never seen a Rahal FUT that didn't work out. Some peoples skin just puts too much strain on FUE grafts IMO.

 

My computer is not working well right now but I think I remember Dr. Feller saying that FUT was better as far as yield, and wanted to link it, but my computer is jacked up.

 

FUE is good for some and not for others IMO. It just depends. I wanted to leave myself in the best position for the most grafts over my lifetime, and since I am 33 (not too young, but not old either), I felt that by using strip first ai will get the most grafts. If you FUE first and then strip, you are working with all the scar tissue from the FUE. If I ever need to result to FUE, that part of the scalp will be virgin.

 

To each his own. I just haven't sen enough good size FUE's posted by users to totally trust it for me. But I have seen some nice ones like yours.

[scar5]

After all is said and done, I honestly believe that in 2012, strip scars are the result, not of patient preference (as we like to believe), but doctor preference, plain and simple.

 

As a footnote, (and not a personal one) look at Spanker"s comments, Spanker, who seems reasonable in everyway and decent, fresh from his strip procedure, saying that he needs FUE scarring to improve, and FutureHT saying , yes, "great analysis"

 

Spanker was actually was led to believe, after all his research, that FUE scarring is significant enough to tilt the equation, and that scarring needs to be "reduced further" (among other factors)

 

I was in a bar tonight. I saw two lonely guys watching the Olympics from their bar stools, hairy guys everywhere, and the DJ, a little goatie and a shaved head. It is not that complicated after all. THose guys were pushing NW6 and to think they could get a bushy forlock of hair with strip or a gentle buzz with FUE, I still can't beleive it - well, I can.

 

It is the doctors that choose, not us.

 

This whole FUE and strip are horses for courses is just a convenient way to please everyone at the shop - but after the goods are home??

 

I think people should look at Jose Lorenzo"s FUE work 3,4, 5000 grafts.

 

Spanker, I think you should take Dr. Feller has his view about FUE and it"s limits. You know that and that it is not a fact because Dr. Feller says so.

 

FutureHT doc, I appreciatte your comments and the tone in which you deliver them, and it is just a minor quibble, (really minor) but you know who invented FUE. Not Berstein, not Rassman. You know that person has been doing it since 1989 and has been abused, derided and rubbished throughout the 90s by the ISHRS and many of the fine clinics we love and respect. And that abuse laid the groundwork on into the so called 'hype era'.

 

The first FUEs stateside were nasty - big, 1mm punches, and plenty of material for the strip shops to parade. I think sacrring is a non-issue only for caucasians. I don't know about black or asian skin, but I dare say, the same discoloration issues might apply to a strip scar.

[Spanker]

I am on my phone and short on time, but when I say scarring is an issue there are 2 reasons. Visual scarring and sub scarring that you can't see but make your second and third ht's harder to harvest by fue therefore damaging grafts more because of the scar tissue that is in the entire dht resistant area.

 

I am not a doctor and do not have a degree in any type of medicine. 95 percent of what I know about ht was learned here, so whoever reads this should take it for what it is worth.

 

I feel like fue is a good alternative to fut.

 

If someone wants to link a result like capeli or Can't decide or Tao or Bill's or any other homeruns that were patient pics (not clinics) that are comparable and done by fue, I think it could move this conversation along.

 

I'll make a deal, for every patient pic homerun result of 2,500 grafts or bigger from fue, I will post 2 fut home runs from around the same period. It is not scientific, but it is the best "Money where your mouth is" comparison I can think of if we are talking about big cases.

 

No disrespect intended Scar. You have had a rough go and you have some valid points. But instead of a debate, let's do a presentation.

 

I am pretty busy but we can start a fut v fue thread with just patient photos and see if we can get some participants.

 

I may be wrong, and in fact, hope I am. I wish for people to get the best results, and if fue really is better, we will be doing a service to the community by proving it.

 

Either way. Good conversation going on here.

Edited August 10, 2012 by Spanker

[Blake Bloxham]

 

FutureHT doc, I appreciatte your comments and the tone in which you deliver them, and it is just a minor quibble, (really minor) but you know who invented FUE. Not Berstein, not Rassman. You know that person has been doing it since 1989 and has been abused, derided and rubbished throughout the 90s by the ISHRS and many of the fine clinics we love and respect. And that abuse laid the groundwork on into the so called 'hype era'.

 

The first FUEs stateside were nasty - big, 1mm punches, and plenty of material for the strip shops to parade. I think sacrring is a non-issue only for caucasians. I don't know about black or asian skin, but I dare say, the same discoloration issues might apply to a strip scar.

 

Two other names come to mind. Honestly, all I can really say is that science and medicine is such a collaborative process and it usually evolves around the following path: a lot of different scientists are working toward a similar goal with fairly different approaches, and one happens to get there first, get the paper published first, etc. The first time I ever heard about the history behind FUE was in a non-biased FUE textbook and they gave Rassman and Bernstein credit for the article. Still think they both represent the innovative, involved physicians we recommend.

[onejoseph]

Hi,

I am definitely an advanced 6 to 7 Norwood. Have already used FUT and punch grafts to the limit. Pretty much gave up but in the past 2 years have been very pleased with work of Dr. Umar in California (DermHair Clinic) as he has been focusing on the use of beard hair almost exclusively. So far I have had ~ 6000 beard hair grafts (2200 last week) and my experience indicates that by 2 weeks out only a reddening and slight dimpling of beard skin is noticeable. By 3 months out, hard to tell anything was done. Beard hair is helping to fill out my entire scalp. Check out Dr. Umar, $8 per FUE (discount for allowing photo use). Limit is 1500 grafts per day. I have a thick beard and expect to harvest a few more thousand grafts before I'm going to leave it alone.

Joe

P.S. Photo shown is about 5 months out from first beard FUE to frontal and mid scalp (4000 last year). My head is currently shaved (after 2200 FUE to crown). Best results seen at 1 year out.

Edited August 11, 2012 by onejoseph
didn't realize photo uploaded already

[Sparky]

This doesn't have to be yet another FUE vs FUT debate, he asked for good FUE docs willing to tackle a NW6, can't we just tell him some names and be done with it?

 

He has decided he doesn't want FUT, so I would imagine he has done his research in that area and decided he doesn't want a linear scar.

[ej]

Hi,

I am definitely an advanced 6 to 7 Norwood. Have already used FUT and punch grafts to the limit. Pretty much gave up but in the past 2 years have been very pleased with work of Dr. Umar in California (DermHair Clinic) as he has been focusing on the use of beard hair almost exclusively. So far I have had ~ 6000 beard hair grafts (2200 last week) and my experience indicates that by 2 weeks out only a reddening and slight dimpling of beard skin is noticeable. By 3 months out, hard to tell anything was done. Beard hair is helping to fill out my entire scalp. Check out Dr. Umar, $8 per FUE (discount for allowing photo use). Limit is 1500 grafts per day. I have a thick beard and expect to harvest a few more thousand grafts before I'm going to leave it alone.

Joe

P.S. Photo shown is about 5 months out from first beard FUE to frontal and mid scalp (4000 last year). My head is currently shaved (after 2200 FUE to crown). Best results seen at 1 year out.

 

 

would be very interested in seeing pictures if possible

 

Many Thanks

 

ej

[sam1870]

Hello Sparky, thank you for understanding me you are a very smart person I belive, for you know what I wanted, yes I have done my research and I am not willing to take the risk of FUT, not only because of the scar, but the discomfort after the procedure, and no doctor can guarrantee you a good scar because I have done research and asked the best Drs including feller and shapiro, and when they are pushed the will tell you, the scar no one can guarrantee you it will not stretch if your skin is the type that will stretch, I have done very extensive research, I take it this way, at least if my FUE goes wrong and I am not happy I can shave my hair or buzz it, and it will be okay , but when having FUT, it is just not possible and you will be forced to have other operations to FUE the scar to cover it etc............

 

again this is my rational for not wanting FUT, I was so close to falling for the drs telling me you will need fut and this is best for you (eventually it is just easier for them, I dont blame them if I was a dr I would think twice cause FUE is not going to be pleasent for me, while having a team do all the nasty job and all I do is design and cut and stich)

 

welll after pushing these Drs to know how many grafts I might get more with a strip to your surprise I found out that it will be max 1000 grafts more in one session with what they call a big strip and with all the risks involved.

 

again this is my rational after my deep research, also if you research on the net, you will find out some men have numbness in there donor area for life after fut and some pain, cause some people there skin will just not stretch enough, etc......

 

again this is my view on the matter, and what I found out from my research, and what I concluded, and not necessarly right but if you think about from a patient point of view whos own head will be cut and who will be under the knife and risks, you will differ than Drs, again this is life and now one will help you make the right decision but yourself because at the end you will be the one ending up with the consequences not anywone else.

 

in conclustion, I would risk having less than optimal results with FUE, rather than being tighed up with a certain scar from ear to ear + all the possible risks and complications that might arise. it took me about 8 month of deep research to come to this conclusion.

[Sparky]

I had some bad strip HT's and had to get FUE into the scar, so my point of view regarding strip is somewhat jaded. That being said, even with the possibility of getting more yeild from strip, I would still advise to try FUE first. You can always ask the Dr to leave a 'strip' area alone and harvest FUE outside this area, so then the FUE that had been taken before wouldn't affect the strip density.

 

Like you say if you don't get what you want from FUE in a few surgeries, you can shave down pretty short without signs of surgery.

 

If FUE had been available when I first made the mistake of having an HT, my head would be in better condition than it is now.

 

Where are you based?

[sam1870]

well sorry to hear that Sparky, I wish you the best and it wasn't your fault, at that time there was no other alternative than having an FUT.

 

I am based in dallas,tx

[Sparky]

My other alternative was to do nothing, which would of been much much better!

[sam1870]

well I almost fell for it many times in the past 10 years, however I dont understand why is it so bad since you had fued you scar? do you have any pain or any discomfort?

[Sparky]

Not really, just regret the whole thing.