Dr. Paul Shapiro-8 Months Post Op FUE RESULT – 2226grafts/4497hairs

[Janna]

[SADbutTRUE]

very nice natural result. good job by doc and staff

[StaggerLee123]

In my mind this is an absolutely beautifully done hairline. Very well done.

 

I've been out of the loop for a while on SMG's FUE protocol, so forgive me if this has been covered. Janna is that done over one or two days? Manual punches used? Is Dr. Paul doing the extractions or does the other Dr J do them? No more ARTAS correct? Is an implanter pen being used or slits? Are you graft survival rates coming close to your strip results? Thanks!

[Janna]

Thanks Sadbuttrue & StaggerLee!!

 

Stag,

 

Thanks for your questions and interest in Shapiro Medical's FUE protocol. You are correct, we no longer have the Artas. It's been over a year since we've stopped using it.

 

Currently, Dr. Joe and I do the extractions together and we've come to really prefer the sharp punches because they go through the skin just above the nape much easier than when we were only using the SAFE dull punches. The device that holds the punch is also much lighter and quieter. Dr. Joe usually starts off making the punches and I'll follow up on the other side of the patient by pulling out the grafts. The extracted grafts go immediately into the Hypothermosol solution and they are sprayed with Liposomol ATP on a regular basis throughout the procedure. Once Dr. Joe completes a section of punches, then we'll switch. This protocol keeps us fresh and maximizes efficiency. Dr. Paul and Dr. Ron are doing some extractions but they don't do majority of them on a given case.

 

We are comfortable scheduling a patient for 2000 grafts in a day but if the patient wants more than 2000 grafts, then they'll likely be on the schedule over 2 days. This particular patient was done over two days - approx. 1550 on day #1 and the remaining on the day #2 because Dr. Paul decided he'd like to dedicate the second day for refining the hairline.

 

We still implement the traditional implantation technique of using our skilled, experienced technicians using fine forceps.

 

I think that our yield for the FUE is getting very close to that of our strip with the use of our holding solutions, ATP spray and ACell. I do think that yield in general for FUE procedures are still slightly lower than that of strip, however. I read on another forum that one of the Turkish doctors told his patient to expect 85% yield. I've personally heard from quite a few FUE doctors say 70%-90% is the norm. I am usually surprised by how much hair is moved for some of the FUE results I see online.

 

Thanks again for your interest and I hope you are doing well!

[PupDaddy]

Beautiful FUE work, Janna!

 

Good use of donor, with plenty still in the bank, and refined hairline work as always.

 

Always interesting to see how even a modest advancement of a receded hairline shaves years of a guy's appearance.

[Dr. Paul Shapiro]

StaggerLee

Your question about survival is a good one but the answer is complex. When we talk about the survival of our surgeries we are honestly going by gut feeling and what we know should look like 95% survival.

To truly know the survival of a transplanted area, the area needs to be tattooed and photographed prior to surgery. The pre surgery photo gives us a count of the hair present before surgery. Then the incisions made need to be photographed and counted. Lastly, the grafts need to be planted and can be re-photographed. Most studies done this way are done using 1 sq cm tattooed boxes. In a year we can then take a photo of the tattooed area and count the number of hairs. And even using this method is not accurate because about 10 to 15 of a person’s hair is in the catagen stage and cannot be seen.

The only way to really measure survival is to transplant onto a completely bald head and mark out sq cm areas with a tattoo.

Some studies have been done using this technique but they are done with very few grafts. If one studies 5 areas and plants at a density of 40 FU/sq cm in each box, then that is only 200 hairs. That is a lot less the planting 2,000 hairs and it takes a lot less time. The studies that have been done show that even under the best conditions we do not get 100% survival but can achieve 95% survival.

At SMG we have a good feel for what 95% survival should look like since we have done so many surgeries. But we do not accurately measure the survival and I am not aware of any clinic that does. One of the main reasons is that not many patients want 1cm square boxes tattooed on their scalp.

As Janna said the survival of our FUE cases using special holding solutions, ACell and ATP spray are getting better and are approaching our strip survival. But I do think overall the survival is best in our strip cases. But since we are not doing exact measurement and comparisons, this is just our observation.

I hope this better explains how we judge survival.

[fortune11]

Dr Paul and Janna -- Thanks for the detailed insight into your technique , I found it very useful. I received an FUT 2+ months ago from Dr Ron and am looking into another , final HT session perhaps in a year's time which will likely be FUE into crown area .

 

One item that wasn't obvious to me --- is the sharp punch manual or motorized ?

[Janna]

Fortune,

 

It won't be too long before you're able to share your hair growth with us. We're looking forward to following your progress.

 

We use motorized device because it's able to give consistent punches efficiently. With our protocol, there's no fatigue or loss of control of depth and angle of the punches. Some patients researching into different FUE techniques assume that "by hand" technique to be superior or that it takes more skill to do it by hand than with motorized decvices. I don't get why one needs to "feel" for the follicles with each punch. The main reason given has been that follicles need to be felt by hand. With good loupes, you're able to adjust for the angle and direction of the follicles when a motorized device is used. The depth of the follicles in a patient can be determined with 4-5 punches at the beginning as the the depth will then be the same thoughout the head. A skill set is needed for both types for sure but I really don't get why one would be superior over the other. To me it's what feels most comfortable in achieving great, hearty grafts with minimal transection.

 

Thanks for your question.