Input Needed- FUE 2521 Grafts 1 year post op results

[wazaam]

Artas tends to have a higher transection rate than motorized manual.

Why is a tech extracting and not a licensed doctor?

 

Yes I am aware. I did research going into the procedure beforehand and suggested to the patient rep that I wanted manual FUE done. When I arrived at the clinic the protocol had apparently changed and the patient rep wasn't present the morning of my procedure. The surgeon stated the Artas "people" were also present to watch the procedure and that is how they would extract on day one. I don't think this was malicious on the part of the clinic rather the FUE protocol at the time of my procedure. In retrospect I obviously wish I would have spoken up and demanded manual FUE or postponed the procedure.

 

Keep in mind a lot of the negative ARTAS feedback and posts didn't come to light until after I had my procedure done so I wasn't as knowledgeable as I am now. I also hadn't seen any of the ARTAS results as it was a newer tool. We have seen those results now and I personally have yet to see a decent one. There may be some out there that I am not aware of?? I think this was certainly a major factor in the result not yielding more grafts.

 

I am not sure why the tech did all the extractions on day 2 of the procedure. I wasn't aware until it was recently pointed out to me by another forum member that a tech wasn't allowed to extract in the US. I asked about the techs status with clinic during one of my consultations and they stated he no longer works with them. The tech was a nice guy for what it is worth as I spent a lot of time with him (majority of the procedure) he seemed to be very knowledgeable and stated he has been in the business for many years.

[GreatPelo]

Not your fault at all, Wazaam. But very disappointed for the industry as a whole. Although the tech was nice, you didn't pay to be entertained...you paid for RESULTS! Artas and Neograft both sell their units to doctors and make a very handsome profit (Artas for about $225k and Neograft for about $85k)...but it doesn't end there. Did you know they each make a $1/graft royalty that the doctor has to pay them? Guess who pays for this? PATIENTS! Not only are royalties involved in the fast food industry like McDonalds, but now in the hair restoration industry, which I find repulsive. So these big companies take their huge money and pour it into Adword ads on Google and major marketing to pull demand and interests from patients who, unfortunately, are not very seasoned with all that's involved.

 

I'm all for the advancement of technology and methods....but not at the cost of the patient!!

[FUE2014]

Wazaam are you a Rahal patient as he seems to hav had a few negative results posted on here recently?

 

You still have a really good head of hair and I'm betting you have a decent number of grafts left in your donor area, so there are still options available to you. In this case I would ask for a partial refund and move forward and consider another surgeon who specializes in manual FUE extraction to beef up the front.

 

By the way, I note from another forum that you are not on Propecia since your marriage. That could be one contributing factor to you losing native hair through a combination of shock loss and your hair loss simply progressing.

[wazaam]

Wazaam are you a Rahal patient as he seems to hav had a few negative results posted on here recently?

I have decided to keep that information private for now and gather as much objective input as possible.

You still have a really good head of hair and I'm betting you have a decent number of grafts left in your donor area, so there are still options available to you. In this case I would ask for a partial refund and move forward and consider another surgeon who specializes in manual FUE extraction to beef up the front.

I appreciate the kind words. I am hoping the donor is really strong. I did have a lot of multiple hair groupings that were extracted. I have asked the clinic several times about my donor capacity and they have only given vague estimates.

 

I agree 100% in regards to manual FUE. In the hands of the right surgeon I think the yield can be comparable to that of FUT. This was my original intent going in as I stated in a previous post. I don't know of many viable manual FUE surgeons in North America so I may be forced to look abroad. At the time of my procedure I had a very limited amount of time I could be away from my work/family and this factored into my decision on clinic/surgeon to carry out the procedure.

By the way, I note from another forum that you are not on Propecia since your marriage. That could be one contributing factor to you losing native hair through a combination of shock loss and your hair loss simply progresses.

 

The clinic did sell me a laser cap for 2K. They stated they thought it would help. I have been using for 3X week 30 minutes per session. I am not sure that it has provided any benefit to date. I remain neutral about it's effectiveness.

This was a point that got brought up on another forum. Here is my history with meds and my current regimen.

 

I am currently 35 years old. I had the procedure done when I was 34.

 

I took propecia from 22 to 29 but I stopped taking propecia when I was married (30) and have been off propecia for almost 6 years. I felt being off propecia for 6 years and nearly 35 my loss had stabilized for the most part.

 

Hair Loss Regimen;

Keto 2% 2 X per week

Laser Cap 3 times per week

Tricomin 3 X per week

Vitamin B complex

Zinc

Biotin

Azelaic AcidI experienced sides I dealt with the seven years that I was on propecia. I took 1 mg daily. Once my wife and I are done having children I am going to give strong consideration to trying a small dose of propecia or possibly RU58841 as more information becomes available. I think propecia is quite effective but it comes with it's setbacks. My hope as I have stated in other threads regarding meds is that patients have safer options in the future to help inhibit DHT in the SCALP.

[Rawkerboi]

But what's the problem in sharing the surgeon name?

[wazaam]

But what's the problem in sharing the surgeon name?

My reasoning is quite simple I want as much objective feed back in regards to my results as possible. I think the mentioning of any clinic can sway one's opinion good or bad based on my experiences.

[ftbpicks]

Wazaam are you a Rahal patient as he seems to hav had a few negative results posted on here recently?

 

You still have a really good head of hair and I'm betting you have a decent number of grafts left in your donor area, so there are still options available to you. In this case I would ask for a partial refund and move forward and consider another surgeon who specializes in manual FUE extraction to beef up the front.

 

By the way, I note from another forum that you are not on Propecia since your marriage. That could be one contributing factor to you losing native hair through a combination of shock loss and your hair loss simply progressing.

 

Rahal doesn't sell laser caps so it wasn't him

[hairshopeing]

Hi

I think you should be offered a 2 Nd manual fue procedure of what ever number of grafts needed for a good result which is not 300 or so grafts or fully refunded.

 

The good news is your hair looks good anyway before and after but it should be looking excellent with that number in that area! Yes shock loss can and does occur but I'd say that the method used would be the most likely cause of this sub par result!! If we loose as much as we gain from the procedure then what would be the point?? No way at your age you suddenly naturally lost 2500 worth of grafts in 12 months!!

 

Oh and just for the record I'm guessing smg!!!

Who seemed to have several unhappy artas patients, hope who ever did it they offer you either a full refund or if you feel happy trusting them again a free complete session!

 

Hope it all works out for you after a years wait!!

[GreatPelo]

Laser Cap is the least effective of medical therapies. First and best is Propecia (it's a personal decision to use it but doesn't have any side effects in case you want to have kids, etc), then Rogaine and then Laser treatment, which is most effective when used with other two therapy choices. Don't want to be negative but I'm not convinced these folks guided you correctly....

 

*Sold you a $2k laser (Finsateride - propecia generic - is cheapest and most effective - $2.50/month)

*Didn't follow through with game plan promised (Artas instead of handheld)

*Tech harvesting donor (should've been the doctor)

*Over estimated number of grafts (2500+ way too much for you)

*Not much of a difference in before/after for money, donor and time invested.

 

Don't mean to throw them under the bus, but too many factors here that don't equate to a positive patient experience. I would consider speaking to another specialist....

 

Best of luck!

[Sean]

Sean,

In response to some of your questions;

Im thinking you wanted some solidifying density up front?

 

Yes given that I still had a decent amount of native hair I wanted to create a refined hairline and improve the density in the front 1/3. I thought with 2500 grafts placed in the recipient zone that would have been accomplished.

Recipient placement and transection played a big role here, it could have also been extraction. How were your grafts extracted? Was this done in one day? Manual or motorized Fue? Were your grafts left out of body for a long time? You got blond hair, that usually makes things look even better after transplantation, or so ot should.

 

The procedure was a two day session. The first day to the grafts were extracted by the Artas robot roughly 1100-1200 grafts. The second day the grafts were extracted by a tech using a motorized punch. Again there was roughly another 1100-1300 grafts extracted on day 2. I have not sure exactly how long the grafts were kept out of the body as I wasn't keeping track. As the procedure was split up into two days I can't imagine they were out of the body too long.

I assumed with my hair/skin contrast the results would be more apparent. The caliber of my hair was described by average/fine. My hair does have a slight wave to it appears a little better than what it is and helps with coverage.

 

Wazaam, what were your ultimate goals or what exactly did you pay for? Density? Filling in the front hairline and for increased density?

 

At this point, i would also get in touch with the surgeon that extracted those grafts and ask for a remedy? Did you present your concerns yet? If not, they may give provide you with some help? Based on evaluating, the surgeon will probably understand your concern and help you out and try to rectify the situation. It's worth a shot to let them know as soon as you can. You can start to get an idea from feedback so far of the outcome. Definitely looks like more than 70% grafts could have not yielded, as the result is not an indicator of a distinct 2521 graft procedure in the zone shown, and thats being generous

 

My goals as I stated previously were to fill in the frontal third and refine the hairline. The temple areas had receded quite a bit and needed to be addressed. There was some slight improvement there from the grafts that did yield. The hairline goals were to add density and refine.

 

I have had a 6 month and 12 month consultation with the patient rep at the clinic. I expressed my concerns during both of those consultations. During my last consultation I expressed that I thought the overall result was quite poor. I even pointed out that the yield on the right side was so poor that I could still see some scalp. The patient rep stated they stood behind there work. I was offered a touch up of 200-300 grafts. I am not sure what 200-300 grafts what even do at this point? If we have already tried 2500 with little cosmetic impact it is my opinion that doing a touch up wouldn't do much for my case. If we throw in the fact that I still have native hair in these areas I may just be compounding the problem at this point?

 

I have asked the patient rep both via phone consult and email to have the surgeon review my results and let me know his thoughts as I had some concerns. I have not heard from my surgeon at all since the procedure took place.

 

I am not sure exactly the percentage that yielded but I would say it was a fairly low amount. There appears to be a lot of transection in my case on top of some of the native hair being lost or damaged.

 

My goal when I created this thread was to get some objective feedback on my results. I obviously am not happy with the results but I wanted to make sure it wasn't me as I know cosmetic surgery and it's results are subjective.

 

In looking towards the future I am not sure if it is in my best interest to pursue a repair or second procedure at this time as there is a lot of native hair to work around? Any feed back on this would be appreciated.

 

 

Wazaam,

 

After reading about your goals, it is evident that they were not met with this procedure.

 

First, was there a reason why you had ARTAS one day and motorized the next? It doesnt make sense why a doctor would do it this way? Did you request ARTAS or motorized FUE per your consultation?

 

FDA filings indicate ARTAS to be used for extracting dark hair, not blonde like yours? Was your hair dyed for the procedure? Obviously, this is another factor to think about.

 

Were ARTAS extractions done by the doc or all techs? Did a doctor oversee the extractions?

 

A tech extracted the following day? If this a procedure that was done in USA then that can have legal ramifications against the clinic and doctor. Surgery especially donor extraction is suppose to be done by doctors only. Did a doctor oversee this extraction too?

 

For Tech extraction references see:

http://www.hairrestorationnetwork.com/eve/166169-fue-extraction.html

 

Also, DrUmar and DrFeller have written of this legal issue on their websites as well.

 

I just read you were recommended lasercap by the clinic to help your growth? I find that ridiculous and the fact you were recommended this by the clinic for growth. What would you need a lasercap for after such a large procedure? Not only that, but you paid 2,000 for that unproven treatment, it is definitely not like Propecia or Rogaine. Your scalp hairs are not seeds that stimulate to laser light for growth as plants grow to the sun. See http://www.hairrestorationnetwork.com/eve/150351-list-doctors-who-consider-lllt-quackary.html

 

 

If that laser was to work, then with your transplant and your routine laser treatment , there is little to no improvement now, a year post op. It shows the laser definitely did nothing and as the grafts did not yield well to begin with. I really think your case has grounds for refund and that lowball repair of like 200-300 grafts touchup will do absolutely nothing towards the goals your originally had and wanted. This is absolutely ridiculous, and a well known clinic did this?

[RobertHa]

Hi FUE2014,

 

Just for the record, wazaam is not a patient of Dr. Rahal.

 

At Rahal, we no longer offer Artas Robotic extraction. All of our FUE extractions are completed manually. By doing it manually, we have a higher graft survival rate.

[GreatPelo]

Hi Robert,

 

So your doctors used the Artas but didn't like the way it harvested? Please share your experience with this equipment. I'm sure it will help a great deal of patients considering it.

[RobertHa]

Hi GreatPelo,

 

We tried ARTAS once. However, did not use the machine again.

[wazaam]

Laser Cap is the least effective of medical therapies. First and best is Propecia (it's a personal decision to use it but doesn't have any side effects in case you want to have kids, etc), then Rogaine and then Laser treatment, which is most effective when used with other two therapy choices. Don't want to be negative but I'm not convinced these folks guided you correctly....

*Sold you a $2k laser (Finsateride - propecia generic - is cheapest and most effective - $2.50/month)

 

In regards to the laser cap and the meds. The patient rep strongly suggested that I implement propecia as he felt it was very effective. I mentioned my previous sides and desire to plan for a family and didn't want to take it the time. As I mentioned in the past when I got married I stopped using propecia. I used it for seven years (been off for 6) and I am fully aware of the benefits it has for many men with MPB.

 

The patient rep and I had several long conversations about this topic (propecia). I believe he is a long time user and the input he provided in regards to meds in my particular case has been very genuine and should be noted.

 

The laser got brought up in one of our consultations and it was suggested it could help. I was not forced into purchasing the laser cap by the clinic or the patient rep. It was a personal decision I made.

 

If used in conjunction with other meds their may be some benefit that I am not fully aware of? I have not tried it with anything else mentioned so I cannot comment one way or another.

 

It was brought up on another thread and for me personally it has just added to the frustration as it wasn't cheap costing me $2000.

[Gram]

Have you had fertility/libido issues from finasteride or are you looking to avoid risk?

[wazaam]

First, was there a reason why you had ARTAS one day and motorized the next? It doesnt make sense why a doctor would do it this way? Did you request ARTAS or motorized FUE per your consultation?

 

I am not sure the strategy in regards to the first day Artas and the second day motorized manual? I requested manual FUE.

 

FDA filings indicate ARTAS to be used for extracting dark hair, not blonde like yours? Was your hair dyed for the procedure? Obviously, this is another factor to think about.

I am one of those guys that has varying colors of hair. I spend a lot of time outdoors in the sun with my work. In the winter my hair is a light/medium brown. The procedure was done in Jan. In the summer my hair gets a lot lighter sometimes as light as blonde depending how much time I spend in the sun. The images may have confused some as my hair appears to be different colors. I have never dyed my hair.

 

 

Were ARTAS extractions done by the doc or all techs? Did a doctor oversee the extractions?

The Artas extractions were done by a tech and there was a physician in the room. The physician was not someone I was familiar with at the time.

A tech extracted the following day? If this a procedure that was done in USA then that can have legal ramifications against the clinic and doctor. Surgery especially donor extraction is suppose to be done by doctors only. Did a doctor oversee this extraction too?

A tech carried out the extraction process with a motorized punch on the second day of the procedure.

[Sean]

First, was there a reason why you had ARTAS one day and motorized the next? It doesnt make sense why a doctor would do it this way? Did you request ARTAS or motorized FUE per your consultation?

 

I am not sure the strategy in regards to the first day Artas and the second day motorized manual? I requested manual FUE.

 

FDA filings indicate ARTAS to be used for extracting dark hair, not blonde like yours? Was your hair dyed for the procedure? Obviously, this is another factor to think about.

I am one of those guys that has varying colors of hair. I spend a lot of time outdoors in the sun with my work. In the winter my hair is a light/medium brown. The procedure was done in Jan. In the summer my hair gets a lot lighter sometimes as light as blonde depending how much time I spend in the sun. The images may have confused some as my hair appears to be different colors. I have never dyed my hair.

 

 

Were ARTAS extractions done by the doc or all techs? Did a doctor oversee the extractions?

The Artas extractions were done by a tech and there was a physician in the room. The physician was not someone I was familiar with at the time.

A tech extracted the following day? If this a procedure that was done in USA then that can have legal ramifications against the clinic and doctor. Surgery especially donor extraction is suppose to be done by doctors only. Did a doctor oversee this extraction too?

A tech carried out the extraction process with a motorized punch on the second day of the procedure.

 

 

It's things like this that make me wonder if you are paying for the name of the brand or actual quality the surgeon puts out. They gave you ARTAS day one with techs extracting and an unknown physician present. So, this doctor was not known?

Then the second day, you get a technician to extract the rest of the grafts. Where is the surgeon you chose to do the procedure or obviously chose the clinic for?

 

I don't understand how a clinic can make/change their protocol when a patient requests manual fue in the first place. I dont even know how that first day ARTAS and second day motorized tech extraction makes any sense.

 

Legally, i dont know how it is possible for a tech to extract/score donor area in the US as this is considered surgery?

 

Whoever was your doctor/clinic, really needs to answer some of these questions.

 

I am hoping you get some resolution out of all this. Things like are puzzling? This was appantly done by a well known recommended surgeon or clinic?

[Janna]

I am not sure if I'll be able to address all the concerns and questions raised on this thread but I will try.

 

Firstly, I'd like to post pics taken at our clinic pre-op and use the post-op pictures sent to us by Wazaam.

 

From what I understand, Wazaam spoke to Matt regarding his results and he said that there was a spot that seemed thin so Matt stated we'd take care of it. This is where the 200-300grafts to take care of the thin spot comes into play.

 

Wazaam did indeed have plenty of native hairs present prior to surgery. However, when you looked through the hair with magnified loupes, you see the miniaturized hairs through the frontal 1/2. 2500 grafts is a lot of grafts if used only in the hairline, but as you can see in the immediate post op pics, you can see the circled area that was addressed is close to 100 cm2. Dr. Ron did not want to overly thicken the hairline to conserve donor. It's also not prudent to concentrate on the hairline if you see that there is likelihood of more loss, especially when hair loss prevention meds are not taken. Dr. Ron wanted to replace the area with miniaturized hairs with stable donor hairs. When 2500 grafts are spread out over the front 1/2, the transformation isn't going to be as great as on someone with no hair. It's really to keep up the look of full head of hair.

 

 

 

 

Edited February 19, 2015 by Janna
confusion

[Janna]

It's things like this that make me wonder if you are paying for the name of the brand or actual quality the surgeon puts out. They gave you ARTAS day one with techs extracting and an unknown physician present. So, this doctor was not known?

Then the second day, you get a technician to extract the rest of the grafts. Where is the surgeon you chose to do the procedure or obviously chose the clinic for?

 

I don't understand how a clinic can make/change their protocol when a patient requests manual fue in the first place. I dont even know how that first day ARTAS and second day motorized tech extraction makes any sense.

 

Legally, i dont know how it is possible for a tech to extract/score donor area in the US as this is considered surgery?

 

Whoever was your doctor/clinic, really needs to answer some of these questions.

 

I am hoping you get some resolution out of all this. Things like are puzzling? This was appantly done by a well known recommended surgeon or clinic?

 

Sean,

 

Wazaam scheduled as an ARTAS case from the onset. We would not have disregarded the technique he requested. What we charge for SAFE and the Artas are the same. However, because the Restoration Robotics charges for each punch/scoring, it ends up costing us more if patients use the Artas. From the very beginning of using the Artas at our clinic, our protocol was to use the ARTAS the first day and then use the SAFE device to even out the extraction pattern. There were two reasons as to why we chose this protocol: 1) there are certain areas of the head that is more difficult for the Artas to reach so we'd have to even out the extraction pattern with our motorized device. 2) Despite RR and other well known physicians stating the Artas extracts very good grafts, we wanted to see the donor and recipient areas for ourselves before we went full stream with the Artas.

 

The unknown physician is our Dr. Josephitis who also did the SAFE extractions and helped in running the Artas. Dr. Ron would have done the planning, overseeing the Artas & Safe and made all the incisions.

 

In the US, how each surgeon runs their surgery room differs depending on each state. In the state of Minnesota under direct supervision of surgeons, technicians can extract grafts.

[Janna]

Wazaam,

 

I just read you were recommended lasercap by the clinic to help your growth? I find that ridiculous and the fact you were recommended this by the clinic for growth. What would you need a lasercap for after such a large procedure? Not only that, but you paid 2,000 for that unproven treatment, it is definitely not like Propecia or Rogaine. Your scalp hairs are not seeds that stimulate to laser light for growth as plants grow to the sun. See http://www.hairrestorationnetwork.com/eve/150351-list-doctors-who-consider-lllt-quackary.html

 

 

If that laser was to work, then with your transplant and your routine laser treatment , there is little to no improvement now, a year post op. It shows the laser definitely did nothing and as the grafts did not yield well to begin with. I really think your case has grounds for refund and that lowball repair of like 200-300 grafts touchup will do absolutely nothing towards the goals your originally had and wanted. This is absolutely ridiculous, and a well known clinic did this?

 

 

When a patient says he will no longer take Propecia to stabilize their hair loss but wants other options, we'll speak to them about the laser. We don't do any heavy selling on anything here at SMG. There are patients who have felt they benefited from the laser and we also offer refund on it if patient feel it doesn't work at all. The laser is normally sold at other clinics for $3k, we sold it for $2k.

[Janna]

Hi FUE2014,

 

Just for the record, wazaam is not a patient of Dr. Rahal.

 

At Rahal, we no longer offer Artas Robotic extraction. All of our FUE extractions are completed manually. By doing it manually, we have a higher graft survival rate.

 

There is a confusion on manual and motorized. I understand Dr. Rahal typically uses motorized devices like we do. I speak to Dr. Rahal on occasion and we share info.

[Janna]

Artas tends to have a higher transection rate than motorized manual.

Why is a tech extracting and not a licensed doctor?

 

Yes I am aware. I did research going into the procedure beforehand and suggested to the patient rep that I wanted manual FUE done. When I arrived at the clinic the protocol had apparently changed and the patient rep wasn't present the morning of my procedure. The surgeon stated the Artas "people" were also present to watch the procedure and that is how they would extract on day one. I don't think this was malicious on the part of the clinic rather the FUE protocol at the time of my procedure. In retrospect I obviously wish I would have spoken up and demanded manual FUE or postponed the procedure.

 

Keep in mind a lot of the negative ARTAS feedback and posts didn't come to light until after I had my procedure done so I wasn't as knowledgeable as I am now. I also hadn't seen any of the ARTAS results as it was a newer tool. We have seen those results now and I personally have yet to see a decent one. There may be some out there that I am not aware of?? I think this was certainly a major factor in the result not yielding more grafts.

 

I am not sure why the tech did all the extractions on day 2 of the procedure. I wasn't aware until it was recently pointed out to me by another forum member that a tech wasn't allowed to extract in the US. I asked about the techs status with clinic during one of my consultations and they stated he no longer works with them. The tech was a nice guy for what it is worth as I spent a lot of time with him (majority of the procedure) he seemed to be very knowledgeable and stated he has been in the business for many years.

 

When Matt scheduled Wazaam initially, it was with the Artas so it didn't get changed at the last minute. However, had Wazaam had any misgivings about the Artas, we certainly could have switched it to the SAFE. At the time, we felt the best protocol was to use the Artas for the middle section of the donor (what's referred as the "sweet spot") and then use the SAFE to even it out. The Reps for Restoration Robotics only come if there is a Artas case scheduled. They don't come hoping for us to sway a patient from SAFE to Artas just because they decided to oversee an Artas case.

[Janna]

I believe that Wazaam is currently in touch with SMG and we hope to get him to where he is happy with his results.

[zyzz]

What brand of lasercap is it?

[Whereitgo]

hmmm I'd ask for a refund