Large FUE session broken into two smaller ones 8 months apart?

[zenmunk]

Hi folks,

 

I've been quoted as needing approximately 2000 grafts to restore my hairline. I'm toying with the idea of splitting that number into two FUE procedures.

 

Procedure 1 of maybe 600 grafts to strengthen my forelock (section 1 below) first to see how it grows. My forelock is in fairly decent shape, but there is some diffuse thinning which needs addressing.

 

If after 8 months things are looking good, then go back for 1400 densely packed FUE grafts to widen the hairline which is currently bald (sections 2 below).

 

Of course the numbers quoted for each procedure are guestimates on my part, but they're probably close. I figure I'd accomplish two things that way:

 

1) I'd see if I naturally yield good growth via FUE. If I don't, then it will be limited to a part of my scalp where I still have a decent amount of hair so hopefully it wouldn't be much of a change for the worse, and I would scrap FUE procedure 2. But if I do yield good growth, then I can go more confidently into FUE procedure 2.

 

2) I'm avoiding an FUE megasession which might help me achieve better yield overall.

 

Thoughts?

 

Thanks,

 

z

 

[Sean]

Zen, I think it is a good and safe plan. Very smart planning. Your idea of splitting it into 2 procedures 8 months apart is very reasonable and smart. To get the best yield, it may be the best route to take. 8 months apart and then you can add more safely without endangering your grafts. In the long run, it will probably help you conserve your precious grafts. But remember, there are important factors to consider and that is what methods the grafts are extracted from (manual, motorized, robotic) and the maximum amount of density you will place on your hairline. I like the design you drew as well as illustrating the hairline. Look forward to seeing how you approach this. As always, I enjoy your very valuable posts pal.

[zenmunk]

Sean,

 

Thanks for your input! I'm seriously thinking that's the way I'm going to go.

 

I may even have two different surgeons do the procedures. The first should be done by one who is exceptionally skilled at planting into existing native hair. The second should be done by one who is exceptionally skilled at densely packed and natural looking hairlines. If I can settle on a doc that's really great at both, then all the better, but I won't necessarily limit myself to one doc if I'm not confident that s/he can handle both approaches to the utmost.

 

Given your experience, which extraction method would you now prefer - manual or motorized? We don't have enough info yet regarding robotic extraction.

 

Regarding density, when I was quoted 2000-2200 grafts, it was with a hairline density of approximately 60 fu/cm2 in mind. Do you think that degree of density is too risky?

 

Thanks,

 

z

[Sean]

Sean,

 

Thanks for your input! I'm seriously thinking that's the way I'm going to go.

 

I may even have two different surgeons do the procedures. The first should be done by one who is exceptionally skilled at planting into existing native hair. The second should be done by one who is exceptionally skilled at densely packed and natural looking hairlines. If I can settle on a doc that's really great at both, then all the better, but I won't necessarily limit myself to one doc if I'm not confident that s/he can handle both approaches to the utmost.

 

Given your experience, which extraction method would you now prefer - manual or motorized? We don't have enough info yet regarding robotic extraction.

 

Regarding density, when I was quoted 2000-2200 grafts, it was with a hairline density of approximately 60 fu/cm2 in mind. Do you think that degree of density is too risky?

 

Thanks,

 

z

 

Hey bud, I think your approach is good. Honestly, I am in the middle when it comes to motorized approach. Some arguments I got included things such as, "The tool can heat up possibly & might create more trauma if not extracted properly". I don't know if that may have effects on yield. From my experience, I did have some long term shockloss on one side of my donor area where some grafts seemed to get stuck during extraction (not easily pulling out). Honestly, in terms of quality, I really can't comment yet as I am not there yet fully grown out. I still got till end of September to conclude a full duration of 12 months. However, I have analyzed tons of manual FUE results averaging 700-1000 grafts a session and amazed by yield. A lot of folks have messaged me and explained they prefer manual as they feel it is more hands on warranting the price they paid for fue vs quicker extraction at twice the cost. They also prefer doctor extraction vs technician extraction. The main argument some folks discussed with me were they would rather have lower number of grafts per session at a slower speed with more manual hand control versus faster motorized extraction resulting in higher number of grafts extracted through more machine control. It kind of makes sense.

 

For density, i think with the hair type you have seems reasonable(really fine to medium straight hair). If you had really thick straight Asian hair for instance, i wouldn't suggest high density since thicker hairs need more blood for nourishment and compressing such larger diameter hair grafts in a small area will really be traumatic and will probably naturally hamper your result. With our hair types, I dont think high density is much of an issue to begin with as long as it is done properly. The thicker the hair, the more challenging it becomes to dense pack under FUE. I had 65cm2. Some doctors can do up to 80cm2 successfully if you have the hair for it. So, you with 60cm2 seems reasonable and I do not think it is too risky, especially under your specific well thought approach. I have read so much into this particular subject since my transplant.

 

Watch the punch size used pal, don't use over 1mm punches as your hair type is suitable for .8mm-.9mm extractions since it is fine hair as you mentioned before. I know that for a fact.

 

Again, with FUE, I am starting to believe less is more. The less you have extracted in one day, may enable you to have higher yield in the end. As a sufferer myself, I refuse to give you any advice that may put you in jeapardy so I really want to give an honest, based on research opinion. Please do take it slow as you are suggesting. A lot have people have advised me to do the same. Work in one area and move to a fresh area next. Do not work in the same area later unless there is a cosmetic issue.

 

So, my thoughts are that you are on the right track. I agree with your approach. If I could turn back time, I would probably approach it like that based on everything I have read today as well as what others said to me based on their own experiences. I learned quite a bit.

 

Keep us posted pal.

[s2thoudriver]

Hi Zenmunk

 

2000 FUE is not a mega session. I would go for a single session at 2,000 grafts and save the additional second trauma to the scalp 8-12 months later.

 

I had well over 2,000 FUE 10 weeks ago with no issues at all. The other patient had over 4,200, but they said they wouldn't go any higher in 1 session.

 

Both of us are seeing great early growth, no shock loss and no complications.

 

Rob

[MAGNUMpi]

Great Thread!

zenmunk- your plans sounds well thought out, and smart.

[HARIRI]

@Sean, who on earth wants to get drilled? Screw Motorized FUE. I only believe in the state of the art manual FUE where the real talent is.

 

@zenmunk, Very smart approach and planning. Most of FUE mega sessions in one day are failure, even it yields, it yields poorly. Browse the forum and you will know what I mean. Anything above 2000 grafts should be broken into two sessions. If I were in your place I would even break the 2000 grafts into two days in order to be in the safe side unless you are going with a real FUE doctor who does atleast more than 3 FUE surgeries a week.

[Mickey85]

I think Sean and Harari both explained it better than I could. But some things you should be aware of:

 

-Shockloss in the existing hair. Due to the trauma of implanting into native hair, you will probably look worse for a few months until the hair grows back.

-It will probably be hard to gauge the growth in the forelock where there is existing hair. Monthly photos would help but would still be difficult to gauge the yield in that area.

 

I don't see any flaws in your method however. Good on you for thinking about the potential yield over the convenience of one session and one recovery period.

[zenmunk]

Sean,

 

Thanks a lot for your thoughtful reply. I appreciate you looking out for us based on what you've learned from your experience so far.

 

So, if I were to list your main points they'd be:

 

- manual punch may be the better way to go especially if I'm splitting the 2000 grafts into two smaller procedures 8 months apart,

 

- doctor extraction may be superior to technician extraction,

 

- A hairline density of 60 fu/cm2 would probably be OK for someone with my hair characteristics,

 

- punch size between 0.8mm - 0.9mm should be used if possible.

 

OK, if you were looking for top FUE surgeons who use manual punch; create densely packed and natural hairlines (up to 60fu/cm2); use 0.8mm - 0.9mm punch; accept international patients; extract grafts themselves; and, have consistently outstanding results, then who would make the list?

 

Have you heard of docs like Rahal, Feller & R. Shapiro using a manual punch if requested for smaller sessions?

 

z

[zenmunk]

Hi Zenmunk

 

2000 FUE is not a mega session. I would go for a single session at 2,000 grafts and save the additional second trauma to the scalp 8-12 months later.

 

I had well over 2,000 FUE 10 weeks ago with no issues at all. The other patient had over 4,200, but they said they wouldn't go any higher in 1 session.

 

Both of us are seeing great early growth, no shock loss and no complications.

 

Rob

 

Congratulations on your successful surgery, Rob.

 

Your points are well-taken. However, what constitutes an FUE megasession is not clearly defined. Some people say 2000+; some say 2500+; some say 3000+; and, so on. Also, not everyone does well with FUE (or even strip) regardless of the number of grafts.

 

My plan is to do FUE procedure #1 to strengthen my forelock, sort of as a test to see how well it grows. And, then take it from there. I realize it prolongs the agony so to speak, but I think it may be worth it. I'll be discussing my plan with docs and make a final decision after getting their feedback.

 

z

[zenmunk]

I think Sean and Harari both explained it better than I could. But some things you should be aware of:

 

-Shockloss in the existing hair. Due to the trauma of implanting into native hair, you will probably look worse for a few months until the hair grows back.

-It will probably be hard to gauge the growth in the forelock where there is existing hair. Monthly photos would help but would still be difficult to gauge the yield in that area.

 

I don't see any flaws in your method however. Good on you for thinking about the potential yield over the convenience of one session and one recovery period.

 

Thanks, Mickey. I would expect the dreaded shockloss to bum me out for a while. You know who seems to take a lot of care planting into native hair - Dr. Wesley. My impression of him is he's a pretty conservative, careful and methodical doc. He might be a good person to consider for implanting into native hair. He also does FUE and uses punches as small as 0.75mm.

 

I definitely plan to take monthly photos to document growth.

 

z

[zenmunk]

@zenmunk, Very smart approach and planning. Most of FUE mega sessions in one day are failure, even it yields, it yields poorly. Browse the forum and you will know what I mean. Anything above 2000 grafts should be broken into two sessions. If I were in your place I would even break the 2000 grafts into two days in order to be in the safe side unless you are going with a real FUE doctor who does atleast more than 3 FUE surgeries a week.

 

Thanks for your input, HARIRI.

[zenmunk]

Great Thread!

zenmunk- your plans sounds well thought out, and smart.

 

Thanks, MAGNUMpi.

[Sean]

Sean,

 

Thanks a lot for your thoughtful reply. I appreciate you looking out for us based on what you've learned from your experience so far.

 

So, if I were to list your main points they'd be:

 

- manual punch may be the better way to go especially if I'm splitting the 2000 grafts into two smaller procedures 8 months apart,

 

- doctor extraction may be superior to technician extraction,

 

- A hairline density of 60 fu/cm2 would probably be OK for someone with my hair characteristics,

 

- punch size between 0.8mm - 0.9mm should be used if possible.

 

OK, if you were looking for top FUE surgeons who use manual punch; create densely packed and natural hairlines (up to 60fu/cm2); use 0.8mm - 0.9mm punch; accept international patients; extract grafts themselves; and, have consistently outstanding results, then who would make the list?

 

Have you heard of docs like Rahal, Feller & R. Shapiro using a manual punch if requested for smaller sessions?

 

z

 

Honestly, I think those points listed probably can't be found dominantly in North America. I am sure there are some, but not many doctors here would be willing to do it that way. Dr's have given mixed responses regarding fue. Some say they can match their fut with fue or near it. Some say the yield is just not good. The opinions are all over the place. I think it is up to us patients to carefully analyze everything ourselves and take everything into consideration.

 

My own opinion is that FUE CAN match or be near FUT yield today, but couple of years ago, it was probably unlikely. This is probably due to specific strategies each individual doctor employs. Now with so much trial and error I guess doctors are realizing somethings may work while some things may not.

 

Regarding Manual Punch

I originally thought my doctor would use manual on me as I thought that is how FUE was by the time I got to his clinic. I did have a list of clinics initially and a good portion did use manual punch. Now, I have heard of Dr. Rahal using manual fue by others telling me he has and that some of those guys have posted on the forums and they have had great yield supposedly due to manual fue. Some guys went even as far to tell me some of the results I seen of his fue prior to my surgery were done through manual punch. I talked to him about that but he said "that's not true". So, I guess he has been using motorized for a while and maybe recently acquired the first Artas machine in Canada according to a recent tv interview. I am very anxious to see the results based on extractions from Artas.

 

As far as Dr. Feller, I read he uses his own motorized tool, but will do manual under certain circumstances. I have read various posts from a patient of his regarding manual extraction after having it extracted from his Feller Punch. The doctor has written on forums about the FUE yield in general being less and his waiver or disclaimer supposadely mentions that as well if you decide to get FUE. Even well respected Spex, says fue will leave you wanting and has mentioned there is a yield issue in general with it on the forums in the past.

 

However, as a self-researching consumer, I respectfully differ from that opinion based on what I have seen on multiple forums and talking with people that have gone through FUE. I have seen doctors adequately match FUE especially through the manual extraction method under a slow process. It may be time consuming and less profitable considering some doctors overseas would only extract 700 grafts a day manually as well as possibly plant it themselves. But that wouldn't be much different from anyone doing a 5000 graft strip procedure on a single patient in one day, making the incisions, and having techs implant.

 

Realistically, I think in the end, the real issue is labor hours worked and the amount of time it took to complete a job on ONE patient. The manual process not only takes time, but may take days on one patient if it is a large session. The motorized extraction allows faster extraction and in one day. Another issue here is, not many clinics in North America can afford to have a single patient in a series of 2 or 3 days back to back with limited grafts causing less $$$. I notice clinics try to get in at least one, two, or three patients per day and MOVE onto the next new clients the next day. It will greatly hamper profitability more than it would yield, lol. I just learned that Dr. Feriduni even went from motorized back to manual punch. Maybe he sees something or realized it did not deliver in a couple of his patients.

 

As for Dr. Shapiro, I am not too sure of what exact specific tool or method they use for FUE. In my eyes, they seem to openly showcase FUE without any mention of yield issues and it seems like they do both procedures equally. I think Janna might better explain their method and philosophy when it comes to FUE. She seems to be very educated on nearly all topics and answers every question or gets the answer to almost every question someone throws at her.

 

 

So, back to those points listed earlier, there are probably a handful of surgeons that would make that list. There were talks about Dr. Lorenzo and how good he is with his FUE. I too believe he knows what he is doing with FUE, however, I would not put him as having the type of refined dense hairline I would look for based on my analysis of all of his posted cases. He seems to be really good with ultimate FUE coverage without utilizing body hairs. So, he can pretty much cover you behind the hairline to the back granted you have the type of ammo he needs to get the work done. I would not put him up there in the hairline density department until I see more of his "high density" marketed hairlines ranging from 60cm2 to 80cm2 grown out and combed back clearly showcasing it. He seems to be really good at doing extensively bald cases with his FUE method.

 

Now, again, based on those main points, I'd say there is a doctor in Turkey that has a strong eye towards facial framing and hairline densities. However, he does not take larger norwood cases for FUE. That is Dr. Keser. He does I think one patient a day averaging 700 grafts a day in one area of the scalp before moving onto another area of the scalp the next day with a max of I believe around 2500 grafts or so for the entire session (even if it lasts 3-4 days). He does it manually but his results speak for themselves I guess as FUE is his sole specialty and he has been doing it for a long time. I think he was the first FUE surgeon in Turkey if I am not mistaken.

 

Then comes another doctor that is actually is just one of the partners of Milena based on what I saw on her website. I learned of this partnership by going to Milena's website when she was first mentioned. After Spex advertised her, the link to that doctor's website from her website is not really active anymore. It is just an inactive logo. The company is Asmed and the doctor is Dr. Koray Erdogan. I actually knew about this company for a few years as I initially eyed them too. He actually specializes in FUE and does a fairly good job. However, his approach is just like what you are mentioning. I have seen a lot of cases where he does one procedure and then the patient grows and has a partial result but then he completes it later and nails it. It's like a two step approach.

 

Dr. Keser used to be 3 euros but due to popularity he went up to 3.5 euros per graft. He actually is one of the more expensive surgeons in Turkey. Dr. Erdogan is actually much less than that. This is basically due to the typical wages in Turkey and the clients they mostly deal with. Dr. Keser has more international clients and once was going to be recommended here on this forum but the issue with "donor safe zone" made it a concern. My own non-expert analytical opinion tells me that the donor safe zone is subjective. It's universal but there are reasons where it may not be based on how the baldness of your family members are as they age. For example, in my family, they have hair above the donor safe zone area and no one on my moms side is bald. The markings of the "universal safe zone" are not how they are on diagrams/photos/models as I would assume them to be based on my paternal family members scalps. They have really thick hairs above that area as well as below the donor safe zone. If I were to have aggressive balding or an unsafe donor area, then by this age I would imagine my donor safe zone limitation would have been detected.

 

Anyway, I thought I'd add my two cents and answer your question. I hope it helps.

[zenmunk]

Sean,

 

Thanks a ton for all that insight! I really appreciate it.

 

I'm afraid you're right - I'd probably have to leave North America to find an FUE doc that meets all (or most) of the criteria.

 

What do you think of Dr. Bisanga? He's been practicing FUE for quite a while; I think I read around 8 years. I was always impressed with Dr. Bisanga's well spread out extraction patterns. I know he uses a manual punch; uses 0.75mm - 0.9mm punches; accepts international patients; extracts grafts himself (although I think his techs extract most of them); and, has consistently good results.

 

What do you think of his hairline designs and density? Do you think they are natural? Do you think he approaches the 60fu/cm2 range?

 

I anticipate continuing to consult numerous of the best FUE docs about my two-procedure plan and their approaches. Hopefully, I'll be able to choose the best doc for me sooner than later.

 

By the way, motorized FUE extraction is not necessarily a deal-breaker for me. As you know, many patients have had great results with that extraction method. The potential problems with motorized extraction may be somewhat mitigated by having two smaller sessions instead of one big one. Fatigue is fatigue regardless of the extraction method.

 

z

[Sean]

Sean,

 

Thanks a ton for all that insight! I really appreciate it.

 

I'm afraid you're right - I'd probably have to leave North America to find an FUE doc that meets all (or most) of the criteria.

 

What do you think of Dr. Bisanga? He's been practicing FUE for quite a while; I think I read around 8 years. I was always impressed with Dr. Bisanga's well spread out extraction patterns. I know he uses a manual punch; uses 0.75mm - 0.9mm punches; accepts international patients; extracts grafts himself (although I think his techs extract most of them); and, has consistently good results.

 

What do you think of his hairline designs and density? Do you think they are natural? Do you think he approaches the 60fu/cm2 range?

 

I anticipate continuing to consult numerous of the best FUE docs about my two-procedure plan and their approaches. Hopefully, I'll be able to choose the best doc for me sooner than later.

 

By the way, motorized FUE extraction is not necessarily a deal-breaker for me. As you know, many patients have had great results with that extraction method. The potential problems with motorized extraction may be somewhat mitigated by having two smaller sessions instead of one big one. Fatigue is fatigue regardless of the extraction method.

 

z

 

Zen, no prob man. I think Dr. Bisanga does fairly decent work. His hairlines are decent and I think he is good with coverage. I have read in various posts nowadays on the forums that he would push fut on patients that need a lot of grafts in which he feels they have no adequate density. http://www.hairrestorationnetwork.com/eve/166734-i-need-your-advice-had-consolation-dr-bisanga.html . So, if you do decide that route, just make sure your deposit is refundable if strip is the option that is recommended just in case.

 

For FUE, I think what Dr. Bisanga did for his consultant was pretty good considering the fella was completely bald, however, I have never seen that result grown out. He mixed and matched hairs and gave him a look he is comfortable with. Another doc I compare him to, in my own opinion is, Dr. Umar. Dr. Umar I think is better in facial framing and good with coverage for large cases.

 

For Dr. Bisanga, I think:

-He is good with density and probably can achieve the desired density of 60cm2 (I think most docs can nail that number easily especially with our hairtypes)

 

-His hairlines do look ok, but it varies with grafts used and patient goals. I like a couple of his hairlines, while some I have had mixed feelings with.

 

-I have seen multiple step approaches on some of his patients though depending on what level of baldness they were.

 

Keep looking at tons of results man. Analyze them till you are certain. Look at the facial framing, look at the design structure, look at the yield, look at the angulation, look at the even distribution in terms of hair density and design, make note of the type of hair and the numbers planted, and so forth as well as recipient hair counts. It is very important to take all these things into consideration and more when you are analyzing.

 

I agree with you fatigue is fatigue in the hands of the professional. If they are doing 700 grafts manually a day or 4000 grafts motorized a day, in the end, the amount of hours spent working will cause that strain. That's why I think it is best to get estimates asking if a procedure would take a specific doctor 5 hours or 7 hours or 12 hours per day and so forth based on your estimated graft counts beforehand.

 

Remember, the hairline is the most important aspect of a hair transplant. Without it, everything else is tainted. Look through tons of hairlines for FUE.

[HARIRI]

Great contribution Sean. You are indeed a solid FUE fan and believer. So based on your sharp observations and followings. In your personal opinion, Who do you think are the top 3 FUE surgeons in order?

[zenmunk]

His hairlines do look ok, but it varies with grafts used and patient goals. I like a couple of his hairlines, while some I have had mixed feelings with.

 

Thanks again for your thoughtful input, Sean. When you say you have "mixed feelings," what are you referring to exactly? Density? Naturalness of design? Could you elaborate a little more on that?

 

I'm a fan of Rahal's hairlines (like most of us on the forum). I think he's a very talented surgeon, but the issues I have are: 1) he uses a motorized tool, 2) I don't think he goes down to 0.75mm punches (like Bisanga), 3) He hasn't been practicing FUE for all that long, 4) I haven't seen many examples of his FUE extraction patterns; does he spread them out well?

 

I'm more concerned with numbers 1, 3 & 4; less with #2, because he uses 0.8mm punches when appropriate, and that's pretty close. Even if I split my procedure up into two relatively small procedures for safety reasons, I wonder how much not using a manual punch will contribute to the final outcome. If you had it to do over, would you have opted for a manual punch?

 

SMG is also an FUE consideration, but the same concerns I have for Rahal, I have for them.

 

Feller is a strong consideration. He's been practicing FUE for a long time. He dense-packs where needed. His hairlines are very nice. As a bonus, he's close to where I live. The downsides are he's quite expensive; he doesn't use a manual punch (although I wonder if he'd do so if requested...); I don't think he goes down to 0.75mm punches (like Bisanga); and (most of all), I'm not a big fan of his extraction patterns. I feel they are not spread out enough (like Bisanga) and sometimes result in a geometric pattern which is discernible as slightly thinner than the surrounding hair. An example is found in this thread:

 

http://www.hairrestorationnetwork.com/eve/142984-fue-patient-1-year-post-op-also-**update**-2-year-post-ops-dr-feller-patient.html

 

The yield and hairline design are extraordinary in the above case, but the extraction pattern is a little troubling. If you compare immediate post-op donor (which is in post #1 entitled "Just after FUE") with donor two years post-op (which is in post #17, fourth pic from the bottom), then you can see the rectangular outline of the extraction pattern. If Feller had spread those extractions further down and further forward above the ears the way Bisanga does (which is more difficult to do), then I suspect there would be no discernible pattern.

 

***Update: In fairness, I asked Spex about this case, and he thinks the extraction pattern was at the request of the patient, and because the patient had extraordinary donor density, Dr. Feller felt like it was safe. I also concede that the lighting in the pic I reference was very unflattering, and at different angles the donor looks much better. Spex went on to say that Dr. Feller will work with the patient to spread out the extraction pattern (he did so with Spex himself). So, before committing to him, I will make sure that Dr. Feller is cool with approaching my extraction pattern similar to how Dr. Bisanga tends to - as spread out and non-geometric as possible.

 

But I digress. I'm having an awfully hard time narrowing down my choices for FUE. All the surgeons have their strengths and weaknesses. I wish I could take the best from all of them and put them into one doc! lol

 

Bisanga seems to cover all the bases, but I'd love to know more about why you think his hairlines are not quite up to par. Also, any thoughts on Feriduni?

 

Thanks,

 

z

Edited August 21, 2012 by zenmunk

[Mickey85]

You aren't wrong about Feller's extraction zones being a bit too condensed. Also, he is not a fan of FUE on large cases at all. Anything regarding more than a hairline tweak or above 1,000 grafts, he most likely would prefer to go FUT. There was a case where a patient went to Feller for FUE(through the motorized method) and was disappointed with the results. On the 2nd procedure it was done with a manual punch and was improved but still not to a satisfactory level. He then went to Dr. Rahal. He has posted his 4 months post op but nothing after. Here is the thread:

 

http://www.hairrestorationnetwork.com/eve/165135-dr-rahal-1413-fue-february-2012-a-4.html

 

Feller has done some outstanding FUE work though and that was the only case I have seen where the results were not satisfactory. Dr. Rahal has some average cases, as do H&W, Shapiro etc. I'm sure you could ask Feller if he could spread the extractions out some more.

 

For me and FUE. Dr. Lorenzo is the only Doctor I would consider. He is FUE exclusive and has 100's of results done via clear video.

 

I can see what Sean means about Bisanga's hairlines, whether it be via FUT or FUE. They certainly do not have the aesthetic appeal that Dr. Rahal or that other unethical Doctor who has the same name as the Italian fashion designer do. Even in Dr. Rahal's more mature cases, the hairlines accentuate their features and frame the patient's face perfectly. The latest Rahal FUE result posted by Matt showcases this. I think Rahal even has Lorenzo beat on actual hairline design. Feller comes in a close second because he actually lets some patients design their own hairlines and then he tweaks it a tad.

Edited August 21, 2012 by Mickey85

[zenmunk]

Mickey85,

 

My strategy is to do two FUE procedures (8 months apart) to equal approximately 2000 grafts. First would address thinness in forelock (I'd estimate 400 - 600 grafts). If that's a success, then second would be to build out my hairline laterally (I'd estimate 1400 - 1600 grafts).

 

With that strategy, Feller may be a good doc to consider, because they are both relatively small procedures. However, that doesn't negate my concerns about his extraction patterns. And, I have seen that thread before which influenced me to strongly consider Rahal instead. But then, we have Sean's yield issue which concerns me. Having said that, both Feller and Rahal have outstanding FUE results (especially Feller since he's been doing it longer). I guess FUE is just more risky, period. Even in the best hands.

 

Does Lorenzo accept international patients? Doesn't he use the choi implanter which seems to concern many people? What are his extraction patterns like? What size punches does he use? How would you describe his hairlines? Clearly, you're a fan, but if you had to point out concerns you have with Lorenzo's work or methods, what would they be?

 

Thanks,

 

z

[Mickey85]

Mickey85,

 

My strategy is to do two FUE procedures (8 months apart) to equal approximately 2000 grafts. First would address thinness in forelock (I'd estimate 400 - 600 grafts). If that's a success, then second would be to build out my hairline laterally (I'd estimate 1400 - 1600 grafts).

 

With that strategy, Feller may be a good doc to consider, because they are both relatively small procedures. However, that doesn't negate my concerns about his extraction patterns. And, I have seen that thread before which influenced me to strongly consider Rahal instead. But then, we have Sean's yield issue which concerns me. Having said that, both Feller and Rahal have outstanding FUE results (especially Feller since he's been doing it longer). I guess FUE is just more risky, period. Even in the best hands.

 

Does Lorenzo accept international patients? Doesn't he use the choi implanter which seems to concern many people? Clearly, you're a fan, but if you had to point out concerns you have with Lorenzo's work or methods, what would they be?

 

Thanks,

 

z

 

With my case(I have a natural zig-zag hairline that I wanted straightened out), Feller suggested that since he was going to be rebuilding my hairline, he would strongly suggest FUT. I don't know if your case would be similar(even if split into two) given that you would want the frontal section worked on. You could always ask him and stipulate that it would have to be FUE otherwise you will find someone else. His extraction patterns do leave much to be deserved however, I'm not a fan of the 'box' donor either.

 

You are correct in that Sean and SugarHigh's FUE results(performed by Rahal) have not currently turned out as they should have. That is disconcerting. No offense to Sean or Sugarhigh at all.

 

In regards to Lorenzo, he does accept international patients(only about 4% of his clientele he told me) but there is a bit of a wait. He does use the choi implanter pen, which some people are turned off by as the grafts 'could' get damaged in the wrong hands. However his videos show that yield is not a problem. I like the fact that he has a 2,000 graft cap per patient/session and does all the extractions, incisions AND implanting himself. He uses a .8mm manual punch as far as I know. His extraction patterns are very clever and extend out to just past the ears. However, I do have two concerns I will divulge:

 

The first is that in his videos, it seems that he traces some sort of laser template for the hairline. I'm not sure if he designs the hairline first and then uses the laser template to see the hairline is straight/skewed etc or if it is only used on some cases. Clearly not all his hairlines are the same so I'm not 100% sure on this. I might ask him actually. I prefer hand drawn hairlines that can accommodate the patient's desires.

 

Secondly and probably more importantly, we have no patient posted results to go by. No clinic would willingly post an un-satisfactory result. As of now, we have only seen Lorenzo's selected results, which all look very good. But are there bad ones out there? How much of a percentage are not satisfactory? That's my honest critic about Dr. Lorenzo.

[zenmunk]

Thank you for your thoughtful reply, Mickey85.

 

I'm a Norwood III with a little thinning in my forelock, so I definitely need my hairline rebuilt. If you go to post #1 on this thread, you'll find a little drawing which indicates what must be done. I've already consulted Feller in-person, and plan to again since he's very close to me. During the initial consultation, I explained that I will only allow FUE. He said that would be OK and quoted me 1300 grafts total which, in retrospect, was way too conservative. Even Spex, his rep, recommended 2000+ grafts (not knowing the Feller quote). Rahal quoted 2000 - 2200 grafts. I think when I see Feller again, I will ask if he would be on board with my two procedure strategy; if he would use a manual punch (no larger than 0.8mm) for both procedures; and, if he would spread out the extraction pattern much more. If he's not willing to at least spread those extractions out and use the smallest possible punch, then I'd definitely cross him off the list. If he balks at the manual punch, then I may cross him off, too, but maybe not. Not too many of the elite FUE docs use manual punches these days, at least not in North America. We'll see. In fact, I may run the idea by Spex first to get his opinion.

 

I appreciate your honest assessment of Lorenzo's work. I agree that your concerns are valid - hand drawn customized hairline design is essential, and a lack of patient posted results is a problem.

 

I look forward to hearing Lorenzo's response to the laser template question when you ask him. Please feel free to post it here or make a separate thread about it.

 

The second problem seems harder to resolve since Lorenzo is not recommended on this forum. What about other forums? Do you know if Lorenzo patients post elsewhere?

 

I'm also intrigued by Wesley's "scarless surgery." I plan to consult him to learn more about it. Regarding regular FUE, Wesley does use punches as small as 0.75mm. I don't know what his feelings are regarding manual punches. I think his hairlines are very natural. Not especially dense, but natural (and if I had to choose I'd pick natural every time). On the whole, he seems like a very careful doc which is a plus. I guess if I wanted to approach a 60fu/cm2 hairline with Wesley, we'd have to do two passes which would kind of suck. That would make it a total of 3 procedures - one for the forelock and two for the hairline. Any thoughts on Wesley?

 

z

Edited August 21, 2012 by zenmunk

[Mickey85]

Thank you for your thoughtful reply, Mickey85.

 

I'm a Norwood III with a little thinning in my forelock, so I definitely need my hairline rebuilt. If you go to post #1 on this thread, you'll find a little drawing which indicates what must be done. I've already consulted Feller in-person, and plan to again since he's very close to me. During the initial consultation, I explained that I will only allow FUE. He said that would be OK and quoted me 1300 grafts total which, in retrospect, was way too conservative. Even Spex, his rep, recommended 2000+ grafts (not knowing the Feller quote). Rahal quoted 2000 - 2200 grafts. I think when I see Feller again, I will ask if he would be on board with my two procedure strategy; if he would use a manual punch (no larger than 0.8mm) for both procedures; and, if he would spread out the extraction pattern much more. If he's not willing to at least spread those extractions out and use the smallest possible punch, then I'd definitely cross him off the list. If he balks at the manual punch, then I may cross him off, too, but maybe not. Not too many of the elite FUE docs use manual punches these days, at least not in North America. We'll see. In fact, I may run the idea by Spex first to get his opinion.

 

I appreciate your honest assessment of Lorenzo's work. I agree that your concerns are valid - hand drawn customized hairline design is essential, and a lack of patient posted results is a problem.

 

I look forward to hearing Lorenzo's response to the laser template question when you ask him. Please feel free to post it here or make a separate thread about it.

 

The second problem seems harder to resolve since Lorenzo is not recommended on this forum. What about other forums? Do you know if Lorenzo patients post elsewhere?

 

z

 

Hmm the only other forums that would feature Lorenzo's work would be Spanish forums... i was hoping he would sign up to this forum but it doesnt seem to be happening.

 

I'll ask him about how he designs the hairlines and report back.

[Mickey85]

Wesley is a bit too conservative for me in regards to density and a youthful hairline. Sorry for the typos, im typing off my phone lol. Havent seen too much of Wesley's work however.

[MAGNUMpi]

I'm very interested in hearing who you choose. Sorry if I sound ignorant but where can one go to find all these hairline picture (Bisanga vs. Lorenzo vs. Feller etc.) I see them now and again, but is there one place where a person can compare clearly?