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

[Mickey85]

zenmunk!

 

I emailed Dr. Lorenzo last night(3am my time) and received an email a few hours later with a personal reply from Dr. Lorenzo(as always). Here is what he wrote about how he designs hairlines:

 

To draw the frontal hairline, we are always guided by native front line, which corresponds to the top or superior border of the frontal muscle. In stable patients with small alopecia, as you know, we can be more aggressive and redo that line. In patients with advanced alopecia, as theory says, we are more conservative, but we always reference the native line, since it is the line with which we were born and which better frame your face. But all the lines are different. External elements such as the laser only help. In particular the laser serves us many times to show the patients that a straight line is a curve line in the forehead, for patients who insist much on the righteousness of the line. You can't see it in all the videos; I always take the photos asking the patient to raise eyebrows, and see the top of the muscle and the relationship of the new frontal hairline with the old one.

 

 

So I was correct in that the laser template is used to see if the line is straight. In this case, it is also used to show the patient that the line is also straight. Because many of us seem to think that a straight hairline does not curve upward as it goes toward the temples, but it does. He doesn't use it all the time as evidenced by his different hairline designs but it depends on the amount of loss on the patient.

 

He did give me a link of a forum that does feature Spanish patients posting their results which I will PM to you(not sure if I can post it publicly due to forum rules). And get this, he will be posting here on this forum very soon!

[zenmunk]

Thanks a lot, Mickey85! Dr. Lorenzo's approach to hairline design seems quite thorough. Please feel free to PM me the link to the Spanish forum. I look forward to Dr. Lorenzo's posts on this forum, too!

[zenmunk]

MAGNUMpi,

 

There isn't one place where you can compare all the hairline work of the different surgeons. You've got to find as many results for each doc as you can separately, and then compare them yourself.

 

The way I've reviewed photos is mostly on this site. I use the search function, so if I want to see Feller's FUE cases, I just search for "Feller FUE." In Feller's case, there are a lot of photos of his FUE and FUT work here. He also has a site called fellermedical.

 

I also do a general web search, because there are other hair loss forums on the internet which showcase patient results from these same doctors (and others not recommended here).

 

Regarding Lorenzo and Bisanga, neither one is recommended here. As such, there are very few cases represented on this forum. You can use the search function to check anyway. However, if you do a general internet search, you'll find their work represented on other forums, on their own websites and on YouTube. Bisanga's site is called BHR Clinic. Lorenzo's site is injertocapilar.com, and his videos are on the YouTube channel of the same name.

 

The good news, according to Mickey85, is Lorenzo plans to showcase his work on this forum soon, so keep a look out.

 

z

[Sean]

@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.

 

Hariri, I guess manual may be so time consuming. Motorized fue seems to be a process that is used more and more in North America.

 

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.

 

Mickey, you have made great points. I agree.

 

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?

 

Hariri, that is a very hard decision to make. How do I decide or pick the top 3? Everyone seems to have their ups and downs. It's very hard to pinpoint the top 3. I had a list of like 10+ surgeons to begin with prior to my HT and I filtered them down and for some I even flipped coins. I see it more as a varying decision as I see some surgeons coming out and framing faces well, some creating hairlines well, some creating widows peaks well, some creating temples well, some covering scalp front to back well, and I can keep going with this.

 

I think you have made some valuable contributions and your points make sense as well. I learned a lot from you and you seem to know what you are talking about as you will soon have a 3rd procedure. Regarding believing in FUE, I realize that these days, some fue surgeons are able to work on upper level norwood cases and get results near strip levels. I think in combination with future technologies, it will help expand this procedure more. I am a believer in FUE, but I don't disagree with those that get strip. To each his own, everyone is trying to make the best out based on their needs. But I think the part with superior flexibility lies in FUE for me. I need that the most and from the start, I even considered using beard hairs or body hairs in the future if needed along with SMP or even other hair multiplication technologies as they become available to enhance myself as I age. I personally just want ultimate flexibility without any hint of a linear scar among other concerns.

 

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

 

Zen, honestly, I wish i could post links from other forums to show you exactly what I mean by mixed feelings and Dr. Bisanga. If you would like, I can pm them, let me know. It has to do with both design and varying degree of densities. Also, when looking at results, keep an eye on flash in photos. It can make areas look dense and more refined then it really is. Lighting is important. I learned this too. Compare and contrast clinic pics and user posted individual results.

 

I too am a fan of Dr. Rahal's hairlines and that is why I chose him. He is known for that jaw dropping hairline result. Regarding Dr. Rahal extraction patterns for FUE, I am not sure if you were able to zoom in my extraction pattern somewhere in the beginning of my thread. You can click and zoom in and see the fresh extractions. I shared that but not sure of how many of Dr. Rahal's fue patients have shared it. Would you call my pattern spread out or compressed? I personally think it was somewhere in between and varying. The length of pattern is wide but extractions seem to vary. I am not sure if he uses .75mm as he did not mention that size to me and I was looking for the smallest size that is safe for my hair type. I think with our hairtypes it shouldn't be an issue, but I don't know how many 2's or 3's a .75mm punch can grab, I mostly think 1 hair grafts can be nailed with a smaller punch like that for straighter hairs. Keep in mind of hair groupings as you want to make sure you can get a nice number of those 2's and 3's or even 4's (if density permits as well). Hair counts do matter, and it will help amplify your result greatly. So, if you somehow get like 1500 single hairs successfully with 1500 grafts then it's not going add that bang you are looking for. You may have a little bit of naturalness but you need that added amplifying effect to evenly support that naturalness. So, you may have to mix and match and consider using varying & safe punch sizes. For hairline, one hair grafts may be great to have, but you need something to bulk up the area right behind it and on the sides. This I think is especially important since you have varying fine straight hair. If you had thick and curly hair, you may get more coverage with lesser grouped grafts, but that's not the case here.

 

Regarding motorized fue, if I can turn back time, manual is something I can consider and did. Like I said, I had tons of doctors on my surgeon list and more than half do manual. I have had so many mixed answers about manual and motorized as well. I think motorized in a doctors hand may be good if it is paced. Manual, I think a doctor is forced to pace it. But then again, Micky posted a link regarding Dr. Fellers patient who had motorized and then manual and it still didn't hit the target. I am waiting to see an update by that patient as well since he had it again with a motorized tool and by my doc. http://www.hairrestorationnetwork.com/eve/165135-dr-rahal-1413-fue-february-2012-a-4.html

 

 

Mickey, thanks for your input. Can you pm me the link as well? I look forward to reviewing some of those results. HTN was my primary source of info and showcase results. Ever since after my procedure, I have been reading various forums and different websites as well. Some forums have more FUE cases in general.

 

 

Magnum, you may need to look at various forums. There are tons of results out there. I wish there were side by side comparisons but unfortunately there isn't. You may just have to sift through tons of threads and put them side by side yourself. I guess the best way to do this is to look at all results that deal with your norwood levels and put them side by side. If you are like a norwood 3, don't look at norwood 5 results. It can throw you off. What one person needs, may not cater to your needs or vice versa. Keep it simple. If you need any help, feel free to pm me as well.

 

Zen, definitely look for results that match your hairloss pattern as there are tons of results to sift through. Analyze not just the results but the doctors, their stances, and how they deal with their patients. I think if a doctor has your back after working on you, it is very important. I know the decision is tough, but you are already ahead of the game with your two step approach I think.

[Sean]

Zen, I missed your last question regarding thoughts on Dr. Feriduni. Based on what I have seen, I think he is a good doctor. His hairline seem decent and quite natural. Hariri mentioned in another thread he is no longer doing motorized fue. So, I guess he moved it back to the manual fue method just recently.

 

http://www.hairrestorationnetwork.com/eve/140259-dense-packing-fue-performed-dr-feriduni-3029-fu-single-day-session.html

 

http://www.hairrestorationnetwork.com/eve/142725-dense-packing-fue-performed-dr-feriduni-nw-class-ii-2152-fu.html

 

http://www.hairrestorationnetwork.com/eve/160628-dense-packing-fue-performed-dr-feriduni-%96-836-fu-single-day-session.html

 

http://www.hairrestorationnetwork.com/eve/139033-dense-packing-fue-performed-dr-feriduni-nw-i-ii-2108-fu.html

[Mickey85]

Sean im just at work onq my phone. Will definitely pm you the link when i get home in a few hours.

[HARIRI]

Sean, Mickey85 and Zenmunk, This is the best FUE thread in the forum. Your contributions and researches are outstanding. I agree with everything Mickey85, its like we have the same way of thinking, IMHO The real FUE is in Europe not America. Keep it up guys.

[hairshopeing]

Hi,very interesting and thorough thread! I'd also like the information where I can view Dr lorenzos patients photos and reviews please! Although won't know what there saying it still would be interesting to see some patient results from themselves! Great news that he's looking to post on this site! Thanks in advance for the info!

[Mickey85]

Sean, Mickey85 and Zenmunk, This is the best FUE thread in the forum. Your contributions and researches are outstanding. I agree with everything Mickey85, its like we have the same way of thinking, IMHO The real FUE is in Europe not America. Keep it up guys.

 

Thanks Hariri, although you are definitely more knowledgeable than I am on this topic. I would now have heard of Lorenzo if not for your appeal to bring him onto this forum. I personally do not care much for any other Doctor's FUE other than his. Can't wait til he starts posting here, he is very passionate about his work and describes things in vivid detail.

 

Sean, to me, your extraction pattern looks very clever. Also because you have dense hair, it probably allowed Dr. Rahal to extract more out of every square centimeter. He could have gone further out past the ears but maybe didn't want to risk it.

Edited August 22, 2012 by Mickey85

[zenmunk]

Sean,

 

Sure, definitely PM some links to Bisanga threads on other forums. Thanks!

 

I wouldn't call your extraction pattern compressed. Was it spread out as far as it could have been? Perhaps not. It may have been extended down and forward more. Then again, there may be a very good reasons(s) why Dr. Rahal didn't do that which I'm not privy to. I agree with you, it was "somewhere in between."

 

Great Feriduni links! Thanks!

 

z

[Mickey85]

I wonder how close hair can be shaved down after a LARGE FUE procedure. The general consensus is that a 1 guard on the clippers would not show the scarring, but I don't think we have any 5,000+ graft patients on this forum that can elaborate on what they can shave down to with higher extractions? I know it is largely dependent on density too though.

[zenmunk]

I've often wondered the same thing, Mickey85. It's an important consideration for those contemplating FUE. I'd venture to say that 5000+ FUE would have a big impact on one's donor. Density would take a big hit and scarring would be noticeable. How noticeable? That will vary by surgeon skill, punch size, extraction pattern, remaining density & healing characteristics.

 

Unfortunately, we don't have a lot of post-FUE donor pics/vids shaved down to see the full impact among many patients. As such, I think Dr. Lorenzo's multiple YouTube videos entitled, "Can you shave your head after a HT by FUE technique?" are invaluable.

 

You've probably seen them, but for those who haven't, they shave down numerous FUE patients who have had large procedures (as in thousands of grafts) in preparation for further FUE work. That is something you rarely see.

 

From what I could tell, every one of those patients resulted in white-dot scarring, but the scarring was hard to detect, even up close. From a distance, I'd say it would be impossible to notice.

 

Also, we are rather experienced at looking for these things, because of our shared interest in HT. For the average person, it would probably be undetectable (unless the patient made the mistake of standing too long in the sun without adequate sunblock).

 

I think it's reasonable for most patients to expect to be able to buzz to a #1 after FUE (with a top FUE surgeon) with little-to-no observable scarring. As to graft numbers... Hard to say. Obviously the higher one goes, the more risk involved.

 

Bottom line, HT is a gamble with recipient yield and donor aftermath. No way around it. I'm very curious about Dr. Wesley's "scarless surgery." I plan to consult him in the near future. I believe he charges $100 per consultation, but I think it's worth it to get that information as well as his overall input on my situation. For that money, I would expect a very thorough evaluation.

[chrisdav]

It would be nice to compare a donor supply (from a good surgeon performing strip 6000+grafts ) against a donor supply (from a good surgeon performing 6000+grafts) to see how the scarring differs. Surgery doesn't have to be all in one

[zenmunk]

chrisdav,

 

That would be an interesting comparison. At 6000+ grafts, I think strip would beat out FUE in most cases (if not all). My personal opinion is FUE is best for relatively small procedures. 2000 or less is a safe bet. Hard to say where the cut-off is, though. More may be OK. It depends on many factors. Regardless, I'm becoming increasingly convinced that 2000+ FUE procedures should be divided into two procedures a minimum of 8 months apart for best results.

 

z

[chrisdav]

Would be nice to see some Dr Lorenzo patient's who have had large proportion of their donor supply through fue.

 

Looking forward to him presenting on here as his work looks excellent.

 

Dr Feller was very complimentary of his work and he has recently meet Hasson&Wong and Dr Farjo according to his website.