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Stretchback: Is it all about laxity?


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Guys,

 

While I appreciate the dissenting opinions regarding FUSS and FUE (which both are sub categories of FUT by the way as there is no such comparision as FUT versus FUE), this topic has gone way off track.

 

There's no doubt that many of you prefer FUE and that's fine. However, FUSS (Follicular Unit Strip Surgery) is still a highly coveted procedure and for good reason. Thus, there is no reason for FUE proponents to jump onto a FUSS/strip topic and turn this into an FUSS versus FUE debate.

 

This topic is strictly about minimizing a strip scar. Let's get it back on track.

 

Bill

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I do see Mickeys point about the reputation bearing little importance on the overall ethics of something. On the other side,I do agree with spanker that sometimes the strip bashing is a bit annoying and goes as far as to insult those of us who underwent a strip by insisting that we didn't do our research or weigh our options. if the debate is to continue, you have to be reasonable of both sides and be objective about the facts.

 

 

If a positive reputation built on hundreds to thousands of happy patients and lasting results does not speak positive aspects of strip then I really don't even know what we are doing here.

 

If the Koniors and Shapiros and Hassons and Bisangas of the industry are not ethical, and you cannot see that after extensive research, then what in the world are we doing? After 3 years of research, I have no reason to believe that they aren't, but if anyone would like to chime in as to why they believe that these physicians are not ethical, please chime in. Otherwise, I would argue that part of the reasons that we know these to be ethical practitioners is because of the excellent results that they produce, which is followed by an excellent reputation.

 

 

EDIT:

 

I posted this after you posted that Bill. I agree that this thread is off track, and we should pic it up in a more appropriate place.

I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

View Dr. Konior's Website

View Spanker's Website

I am not a medical professional and my opinions should not be taken as medical advice.

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Robotic FUE? Compare results of top notch FUE docs who have enough skill to use manual instruments to those that use Robotic FUE. Robotic FUE is used by inferior surgeons who do not have the skill to master manual FUE so they spend mega bucks for these machines that in fact do more damage to the follicle. Dr Bernstein was on Oprah promoting FUT. He even said that FUT scars are "Pencil-Thin" and brought a patient on- I bet one of the ones that got a good result- to show Oprah how great his work is. Stay away from Robotic FUE and FUE in North America. THe Monets of FUE are overseas. Bernstein is mostly a strip doctor and when he was on Oprah he sure was beating the drum for FUT. And your long sheet by Bernstein listing all the negatives of FUE is misleading and should include all the positive aspects of FUE also. With just listing the negatives of FUE makes it sound like you have a biased outlook on FUE. Anyways, a pro strip Doctor is the wrong person to be writing about FUE. I'd rather see a list written up by somebody who actually practices FUE full time and knows the good and bad. Very one sided in my opinion. Robots are for those that lack the essential skills it takes to do manual FUE, which is the "Gold Standard" of FUE today.

Edited by CaddyTad77
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Robotic FUE? Compare results of top notch FUE docs who have enough skill to use manual instruments to those that use Robotic FUE. Robotic FUE is used by inferior surgeons who do not have the skill to master manual FUE so they spend mega bucks for these machines that in fact do more damage to the follicle. Dr Bernstein was on Oprah promoting FUT. He even said that FUT scars are "Pencil-Thin" and brought a patient on- I bet one of the ones that got a good result- to show Oprah how great his work is. Stay away from Robotic FUE and FUE in North America. THe Monets of FUE are overseas. Bernstein is mostly a strip doctor and when he was on Oprah he sure was beating the drum for FUT.

 

It is hard to criticise robotic FUE yet as there are not enough results out there to give a side by side comparison against the manual tools and other mechanical devices used when harvesting.

 

The stretching of the scar notion has been blown way out of proportion. There are no statistics available on the proportion of patients with stretched scars. This has been continually perpetuated when there is insufficient evidence to justify this. The only people that have seen hundreds and thousands of scars are the surgeons and clinic representatives themselves and NOT forum members that are emotionally charged that have had no physical interaction with hundreds of patients on a yearly basis for a long period of time like they have. They will be in the best position to conjecture what the likely proportion would be. Nearly all of the recommended surgeons on this forum perform strip surgery to some degree and it would therefore class the large majority of them as "unethical" which is ludicrous and utterly mad.

Edited by chrisdav

2 poor unsatisfactory hair transplants performed in the UK.

 

Based on vast research and meeting patients, I travelled to see Dr Feller in New York to get repaired.

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I don't see what's wrong with using robotics, provided that it can provide equal results as to what a human is capable of providing, which at this point is unknown. Anyone who claims otherwise is arguing on pure emotion and is not a person who is excited to advance the field. I see several advantages to robotic harvesting that I will not go into here as it really makes no difference. Human's have used technological advances to make our lives significantly easier. You don't see humans building fire to cook their food. You don't see bakers mixing their doughs by hand, you don't see doctors drinking pee to test for diabetes anymore, because not only would that be silly, it's also less effective. Does that mean the doctor is a worse doctor because he doesn't want to drink urine to test for diabetes? Does that make the chef worse than a family on a camping trip cooking food over an open fire? Does that make the chef less SKILLED than someone baking at home without the high tech gadgets? Absolutely not.

 

No matter what you think, there's always a way to improve no matter what it is we do. Those who are stuck with the idea that modern methods are the best and anyone searching for a new way to provide better results are (insert negative adjective here), really shouldn't be complaining that strip surgery is still in our industry

My Hair Loss Website

 

Surgical Treatments:

 

Hair transplant 5-22-2013 with Dr. Paul Shapiro at Shapiro Medical Group

Total grafts transplanted: 3222

*536 singles *1651 doubles * 961 triples,

*74 quadruples.

Total hairs transplanted: 7017

 

 

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The top FUE doctors in the world, and its not just my opinion but a fact are-

Dr Koray Edgoran

Dr Lorenzo

Dr Bisanga

 

Those are just a few.

None of them use Robotic FUE

 

Robotic surgery has its place in other areas of science like cardiovascular surgery. But for Hair Transplantation it is an inferior tool and a very gimmicky one at that. Some surgeons do not need to spend over 50,000 bucks or more for an Artas or NeoGraft machine because they have the skilled hands of a true surgeon so they can extract the grafts with less trauma. If the top FUE guys in the world thought that these machines extracted quality grafts, believe me they would have them in their clinics. Robotic FUE serves the Doctor more so than the patient. It saves the Doctor time while making him money. There is a reason the Top FUE guys in the world are the best. Dr Lorenzo, one of the well known FUE surgeons who does manual FUE, recently praised Dr Koray Erdogan's one-step extraction method. Both surgeons could have Robotic FUE as it would only save them time and make them more money. But they believe in themselves as artist. Back in the victorian days they had this amusing novelty piano that played itself. I guess the music sounded okay, but I'd rather here Chopin played by a pianist than listen to it on a machine. Just an analogy, but I think you get my point.

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The top FUE doctors in the world, and its not just my opinion but a fact are-

Dr Koray Edgoran

Dr Lorenzo

Dr Bisanga

 

Those are just a few.

None of them use Robotic FUE

 

Robotic surgery has its place in other areas of science like cardiovascular surgery. But for Hair Transplantation it is an inferior tool and a very gimmicky one at that. Some surgeons do not need to spend over 50,000 bucks or more for an Artas or NeoGraft machine because they have the skilled hands of a true surgeon so they can extract the grafts with less trauma. If the top FUE guys in the world thought that these machines extracted quality grafts, believe me they would have them in their clinics. Robotic FUE serves the Doctor more so than the patient. It saves the Doctor time while making him money.There is a reason the Top FUE guys in the world are the best. Dr Lorenzo, one of the well known FUE surgeons who does manual FUE, recently praised Dr Koray Erdogan's one-step extraction method. Both surgeons could have Robotic FUE as it would only save them time and make them more money. But they believe in themselves as artist. Back in the victorian days they had this amusing novelty piano that played itself. I guess the music sounded okay, but I'd rather here Chopin played by a pianist than listen to it on a machine. Just an analogy, but I think you get my point.

 

You are using the same logic that the leading strip surgeons used back in the day when FUE was in its infancy and a severely inferior form of hair transplantation. These strip doctors were saying that it was bringing back to the plug days and had severely inferior results to strip. That much was true and everyone will agree. However, look at it now; FUE is providing world class results comparable to strip and has evolved into its own market. The fact that none of the world leading surgeons are using robotics, similar to the way that none of the world leading strip surgeons at the time abandoned strip in favor of FUE, has nothing to do with whether or not it is a good, or has the potential to become a superior form of donor harvesting.

 

Robotics as a form of harvesting is relatively new. The world leading FUE physicians have been going at it for YEARS and have mastered their technique. Naturally they are going to be hesitant to try someting new, in a similar way that strip surgeons were skeptical of moving into FUE. That does not mean that it is the only technique, and I reaffirm that it is not the best technique that can be thought up.

 

I do agree with Bill, this is getting a little out of hand. These topics have their rightful place on the discussion forums, but not in a thread like this :o

My Hair Loss Website

 

Surgical Treatments:

 

Hair transplant 5-22-2013 with Dr. Paul Shapiro at Shapiro Medical Group

Total grafts transplanted: 3222

*536 singles *1651 doubles * 961 triples,

*74 quadruples.

Total hairs transplanted: 7017

 

 

Non-Surgical Treatments:

 

*1.25 mg finasteride daily

*Generic minoxidil foam 2x daily

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When I have a top coalition Doctor who is known for his superior FUT work tell me that todays FUE "Is old wine being marketed in a new bottle" I know he is not a master of FUE, nor need he be as his FUSS results are some of the best in the world, I think he is unwilling to unhitch the wagon from the horse because why should he when he is very successful at what he does. Comments like that during a consultation are not only dishonest, but irrational and only reinforce my belief that in this industry you don't know what to believe or what is true. But as a former soldier I know when it's time to lay down my weapon and walk off the battlefield. Some wars are just not worth fighting for. Hopefully any first timers getting a hair transplant will be guided in the right direction and not fall for goofy assumptions based out of fear and envy. My advice to any newbie is take your time, research as much as you can, and during a consultation whether it be FUE or FUT make sure they tell you the good and the bad. Let the white flags fly homies!!!!!

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The unwillingness to change often comes back to hit a person in the butt twice as hard. If donor doubling turns out to be as what is claimed, strip WILL be a thing in the past and those strip doctors who didn't invest time into learning the trade will be behind in the game. However, the time isn't now - FUSS still has its place in the field, and strongly.

 

I am a strong advocate of research. Although I didn't research for two years like some people, I researched enough to have made an informed decision and risk assessment based on the specific needs of my case. If I would have gone with FUE, I would have never been able to achieve an appreciable amount of density that I would have been satisfied with.

 

I know that when I talked to Matt at SMG, he made it clear that it is a surgery and with every surgery there is risk of a stretched scar, although they are very good track record with their scars.

My Hair Loss Website

 

Surgical Treatments:

 

Hair transplant 5-22-2013 with Dr. Paul Shapiro at Shapiro Medical Group

Total grafts transplanted: 3222

*536 singles *1651 doubles * 961 triples,

*74 quadruples.

Total hairs transplanted: 7017

 

 

Non-Surgical Treatments:

 

*1.25 mg finasteride daily

*Generic minoxidil foam 2x daily

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For some people the risks associated with FUT are not a worry. I have a very tight scalp and do not want to risk a stretched scar, or scalp numbness which is real and maybe rare but a patient should know beforehand what they are getting into. And is it worth it, whether it be FUE or FUT, but I choose FUE because for my case I think its best as I would not want to sacrifice any amount of hair on the top of my head if it gave me lifelong suffering. Some guys do not have that problem and have great results with FUT and very fine scars. But there are guys who went in thinking they would be okay and the scar stretched. If you have a very tight scalp I think it's best to avoid FUT. For guys that are athletes and play sports and cannot take months and months off FUT is not a good option. I'm not saying FUT is bad. I've seen great heads of hair via FUT. But I have also seen great heads of hair FUE. Both give equal yield in growth. Its just what is best for you. I think in the right hands FUE can give results equal to strip. When I had a consultation with a very well known strip surgeon he never mentioned that I could get a less than optimal scar, all he said was that it would be pencil thin. I think a patient deserves to know that the scar might not turn out great, and the patient should know that he could have permanent scalp numbness or a feeling of tightness on his scalp. What bothers me is when you read the consent form it clearly says -I agree that this surgery might result in permanent scalp numbness- I agree that I might have headaches or scalp tightness. These things should not just be mentioned on a piece of paper, they should be talked about as much as pencil thin scars are talked about during a consultation. That is my account of what I went through.

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FUE having positive attributes does not negate the advantages of FUT either. I got this off Dr. Bernstien's site because I am too busy to write my own, but I may consider doing it when I finish grad school in 2 weeks.

 

Saying that it is ultimately more invasive is not necessarily true either. I would argue that your total scarring is probably greater. Also, saying that FUE is more efficient at obtaining hair is debatable as well. While I liked a lot of the work that you have done found in your signature, blanket statements like that look good, but it kind of sounds like a politician's statement; there is a lot more to it than that type of blanket statement, but you are saying it like it is a fact, which, in fact, it is not. I am not ignoring any facts, I just understand that they are way more complicated that you are making them out to be in that small paragraph.

 

[/b]

 

I'll make this my final post in this thread just to explain where I'm at.

 

I'm saying that the advantages of FUE make it a suitable replacement for strip in most cases. I feel(feel, as in, my opinion), that strip is too invasive for most cases as they could be resolved via FUE with far fewer drawbacks. Does that mean it can treat 100% of patients? No.

 

In terms of strip being more invasive. I totally stand by that. The surgeon is cutting a 20cmX1cmX1cm strip of flesh out of the back of someones head. FUE does not go nearly as deep. Does FUE cause more collective scarring? In most cases, definitely. But the cosmetic impact is far less visible. But I totally agree the collective scarring is more.

 

In regards to strip being a more inefficient means of obtaining hair, you are removing a large section of skin, tissue etc to get to the grafts with strip. Whilst with FUE, you are removing the grafts themselves, right from the source. It is pure economics.

 

I will comply with Bill's request and have enjoyed conversing with Spanker as always as he is civil.

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As with Mickey, i'll make this my final post on the subject.

 

 

The initial question/text was was regarding avoiding stretched strip scars.. my answer is simply.. avoid the risk completely but not having strip surgery at all, especially as there is no need to in this day and age.

 

 

With regard to robotic FUE, this hits the nail on the head "it would only save them time and make them more money". Less surgeon time in theatre (as with strip surgery) for the surgeon = more profit.

 

However, if a patient, for some reason can't travel to regions around the globe to clinics that are producing outstanding FUE results on a daily basis, that have been doing FUE for years and who simply won't do strip surgery any more as it is an old technique with risks associated, or will only have their HT done where the available surgeon has mastered their stip technique but is average at FUE, then all i can do is wish them good luck and hope they aren't dissapointed.

 

My sole aim here is to try and help others get great results with minimal scarring and help avoid any subsequent repair work and even phychological scars. If it means repeatedly getting into these discussions then that's all good.

 

There will always bit strip supporters and FUE supporters, until the strip surgeons move on to FUE or other techniques and master their new art.

 

Rob

2800 FUE, Istanbul

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I have a very tight scalp and do not want to risk a stretched scar

This brings me back to one of my first questions: if a person with a tight scalp does 3- 6 months of scalp stretching will they effectively have a loose scalp and good laxity?

I mean is there actually almost no one who would have to walk into am operation with a tight scalp? or is this incorrect?

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This brings me back to one of my first questions: if a person with a tight scalp does 3- 6 months of scalp stretching will they effectively have a loose scalp and good laxity?

I mean is there actually almost no one who would have to walk into am operation with a tight scalp? or is this incorrect?

 

I did 2 months of excercises and feel that they made a difference, even after just a couple of weeks. I think my laxity was good before, perhaps very good on the sides and decent on the back.

 

Post operatively I only felt tension right at the back but elasticity seemed to improve a lot between weeks 2-3. That's not to say I don't take care about head movements anymore, but I don't worry about it too much and normal day to day stuff is fine.

4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020

Proscar 1.25mg every 3rd day

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Stretches were encouraged so that a bigger, wider strip could be taken, not to reduce stretch- back. The story went, in the hands of the an expert and morally upright strip surgeon, a scar would be pencil thin,

(apart from the disclaimer you signed saying there are no guarantees with scars so don't bitch about them) . If he docs were saying stretch because of stretch back, then all the guys who went before the stretching craze were duped!

 

In my experience, I've had scars continue to get worse for up to about five months, but there is a period between five and ten weeks where there the opening up was most rapid.

 

Of course, post-op protocol is important, but strip docs don't want to discourage you from doing strip, so be careful for as long as you possibly can, and then for a little longerl, (some say exercise is OK after two weeks!) Of course, it would be more sensible to do FUE if you have any concern about stretching.

 

The more stretching you do, the more you will ease out the telegen hairs so you are likely to increase the percentage of hairs lost in 'the wash' so to speak. Empty follicles are invisible in effect.

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