Buyer beware. Is this what you expect from 6800 FUE?

[Dr. William Lindsey]

This nice guy in his 50s called a few weeks ago and I ended up coming in on a Saturday to meet the guy and see if this story held water. I believe its truthful, given my interaction with the man and a couple of other similar cases I've seen.

 

This reasonably healthy pacific island man says that he had 2 2500 neograft cases a month apart about 3 years ago. Then when he confronted the doctor about low growth, he was reassured that it was growing and paid for another 1800 neografts.

 

The first picture is of his recipient area, and he's class 5 or more. His preop pic looks to me like he's gotten maybe 1000 to 1200 HAIRS from his $20,000.00 investment.

 

The donor area is the second picture. I see THOUSANDS of depigmented spots. That is the bad news. He's full of scar. The good news is that many of the depigmented spots have hairs growing out of them. Good news you ask? While I wasn't there...having done a fair amount of FUE I think I know what happened.

 

Lots of punches were made, and you'd think that in a straight hair guy like this, it would be like taking candy from a baby to come in at the correct angle and get nearly a 100% success rate. However, the U in FUE may stand for unpredictable....and sometimes you just either can't get the right angle OR the hair avulses off and leaves the root, which regrows hair.

 

All of us have had cases where you have a few hairs like this and all of us have had guys who it just was tough to get any FUE's out. In fact just a few months ago I did, or started, an FUE to fix a strip scar (from elsewhere) with FUE. Same Pacific island as this guy....I figured we'd get 200 FUEs out in 30 minutes and be done in 3 hrs....After 2 hours of trying, and seeing significant hairs pull out without a root, and making 100 punches using a hand instrument, feller instrument, safe instrument and just not having luck at all....we stopped. Better to stop than to keep scarring the guy's head, no matter how small the punches are, than to keep going without success.

 

So I would guess that the techs, who, per this man, did the entire case, just kept going, root or no root on the hair, and hence there is nothing to show for that large investment of money and time and ouch.

 

The last bit of good news is that while he has 6000 punch marks in the donor area, he still has a LOT of donor hair. I hope we'll be able to do a strip repair and then see how he grows.

 

You know, there is no guarantee that any hair case will work...but to get 5000 FUE's with no growth, and then pay for another 1800 and have no growth and no depletion of his donor area is just not ideal.

 

While I can't guarantee a strip will work on him either, I am sure we'll transplant viable follicles and I expect SIGNIFICANT growth.

 

Bare in mind these are the best pics I can get until he's actually our patient.

 

Stay tuned.

 

Dr. Lindsey McLean VA

[TakingThePlunge]

That's a truly sad story Dr. Lindsey but it certainly could have been much worse. A very expensive lesson learned.

 

I hope we'll get to follow the patient's next procedure. I'm glad he found his way to good hands.

[Melvin- Admin]

I can't really see the donor scars, do you have any better pics, the growth seems poor though for sure.

[MAGNUMpi]

Sounds more like it was an unqualified doctor and his techs, not FUE itself. If they were any good they would have stopped, like you did, and consulted with him. Also they would not have told him his growth was ok and got him for more grafts after the fact.

Bad doctor. Not bad procedure.

[Dr. William Lindsey]

HT soon....that is the best I can do with the limited access I had to his head in an initial consultation with a pissed off, nervous guy (and rightly so). You can see lots of little white spots, most actually have a hair coming out of them....consistent with my theory that the roots were left and rootless hairs were harvested and planted.

 

IF we get to do a repair case on him, which I do expect, I'll have lots of pics of the head for illustration.

 

Magnum PI I agree. However, there are guys who are just virtually impossible to FUE for one reason or another. It could be deep scar tissue from old trauma, consistently inconsistent hair emergent angles from the scalp, or simply really weak connective tissue around the root bulb. I'm only guessing, but I'd say that played a roll here, and in the genetically similar very straight hair patient that I couldn't extract hair from. It just happens. AND given a number of similar (albeit significantly smaller case size) patients that I've seen this calender year with poor FUE results from several well known doctors....I think that this phenomenon is not that uncommon. Shoot, we see that weak connective tissue in strip cases too...when the cutters complain that the cubes are just falling apart. It takes time, careful technique, and minimal tension on placement to get those hair cases to work...even with strip!

 

Dr. Lindsey McLean VA

[Dr Blake Bloxham]

Dr L,

 

Glad you were able to consult with this patient. I really hope you're able to help him out.

 

I know there seems to be a lot of harsh criticism of FUE lately. Echoing Mag above, there is a time and place for FUE; there are also varying degrees of the right and wrong way to do it.

 

Having said that, this case is an example of an FUE reality that I feel isn't discussed enough. Especially as some doctors move towards larger sessions in one sitting, more aggressive designs, and big cases on young patients.

 

This gentleman has a big problem here: not only does he have poor growth, but now his donor is very compromised. Had he undergone a smaller FUE session that left a lot of virgin tissue between extraction sites or only harvested from one portion of the donor region (which creates another problem in-and-of-itself), he would still have good tissue to use for future procedures. Same thing if he did strip (or mFUE), but we won't go down that road today (haha).

 

But you can't do this with a large FUE session. If you want to extract a large number of grafts, you really can't skip around (which is another reason why the "cherry picking" argument holds little to no weight where big cases are concerned) and you MUST score a lot of sites. Why? Because you're always going to have some ratio of sites scored to failed graft delivery (IE sites that were scored, but the grafts couldn't be delivered or they were delivered unsuccessfully).

 

This is why you better grow WELL if you're doing a big FUE procedure in one sitting. It's a pretty high stakes gamble.

 

So now, his donor is very, very questionable. Even if a strip is successfully taken, it's still going to be very thinned out and he's not going to get great yield from it. What's more, the thinned out donor area is now going to make the strip incision more visible. And I highly, highly doubt this gentleman could have any more successful FUE. Way too much subdermal scarring.

 

Now, I know what you're thinking: "Well, it's FUE. He can just shave his head and move on." And for a smaller case, I think this could be an option. But it's important to realize -- and I've seen enough of these in person now to get it -- that even a post-FUE head still has a "surgical" appearance when it's shaved down. Now, I won't sit here and say that it's more conspicuous than a bad strip. But there is definitely something still noticeably different when you truly shave these guys down (0 - 1 guard). And clearly this guy's goal was never to shave his head in the first place.

 

I hope they at least used small blades or needles in the recipient? At least this will minimize the fibrosis up top and help the subsequent procedures.

 

Either way, I wish this patient the best of luck.

 

/rant

[Melvin- Admin]

It's very unfortunate for this individual, I'm tempted to think perhaps he went to one of these supposed "hair regeneration" clinics that basically intentionally transect the follicle in order for it to grow back. With that being said, these cases exist with FUT as well, like magnum pi said its not the procedure itself rather the physician and the clinic, I could post countless repair jobs where FUT patients go to FUE physicians for repair, but that doesn't necessarily hold any bearing on the procedure itself. I agree with Dr. Bloxham, FUE is best done in sessions, this ensures you get better growth and your donor area will be a lot better.

[Dr. William Lindsey]

Yes this guy was snookered. No doubt about it.

 

Without getting into details that could be called slander...several guys that I've seen like him are getting surgery, reportedly, by doctors of numerous specialties who have gotten into hair to add a "profit center" to their practice.

 

I get the flyers, emails, and calls WEEKLY from the sales guys trying to push this to boost my Ear Nose and Throat practice. (I'm listed as an otolaryngologist and facial plastic surgeon with numerous insurance companies that pay for the skin cancer defects that I repair every Tuesday--despite the fact that I haven't done ENT this millenia). But the sales guys have a slick presentation about how an 80k or 300k investment will yield zillions of dollars and constantly successful hair cases.

 

My buddies who do ENT do work very hard and given the decreased reimbursement from surgery, they have added allergy treatments and hearing aids to their practices to supplement their income. It is very tempting to these guys to get into hair...particularly when there are companies that essentially make it turn-key, supplying the techs etc....

 

Then, when the first bunch of guys don't actually turn out like the marketing guys promised, not only has the patient been duped, but now the doctor has a bunch of trouble.

 

Only via research BEFORE a purchase, whether it be hair, cars, a spouse...etc, can you minimize, not eliminate, the chance for snookerization.

 

Dr. Lindsey McLean VA

[Dr Blake Bloxham]

Dr Lindsey,

 

I agree. Taking all other emotional aspects of the FUE versus FUT versus who should and shouldn't perform the procedures debate "out of the picture," I think we can all agree that the marketing of these type of devices to clinics without experience or the willingness to do it right is an issue. A big issue.

 

I hope you'll keep us updated on this gentleman's case.

[Dr. William Lindsey]

Here are 2 screen shots of neograft ads I get a couple of times a month. They appear to be targeting ENT doctors (I am an ENT) and likely others, to add this "profit center" to their practices.

 

I know 2 of my residency buddies have been approached by them reported saying that for a 100k investment they'd run everything, all the doctor had to supply was the license...and office space. I didn't hear that myself but did hear it from guys I shared call with in residency who do NOT do hair, aren't starting, and think its ridiculous to offer surgery without some kind of expertise.

 

I have also heard through the grapevine that my old training institution is buying one to add hair to the ENT department. Time will tell. Having worked at 2 academic centers, I think it would be difficult to have a dedicated team for hair...likely leading to travelling techs and inconsistent results.

 

Buyer beware indeed.

 

Dr. Lindsey

[Bill - Seemiller]

I think very few patients are candidates for an FUE procedure exiting 6000 grafts. And that's true even if done Buy a highly skilled and experienced FUE surgeon. Clearly there are a number of issues with this very sad case. I really feel for him and hope that you will be able to help him in the best possible way. I know given your ethics and high level of skill, that you will do your very best for him.

 

Best wishes,

 

Bill

[Bill - Seemiller]

As an additional sentiment, I will also say that I never liked that NeoGraft marketed themselves as the end all be all of FUE extraction devices and makes it sound that even the neophyte surgeon and inexperienced technicians can use the tool without any skill or practice. This is highly dangerous for a number of reasons but ultimately, it's detrimental to the patient who puts their hope and trust in the clinic they choose. This is just more evidence that patients need to do their due diligence in researching all physicians and procedures they are considering prior to undergoing hair transplant surgery. That is also true with other surgeries.

 

Best wishes,

 

Bill

[win200]

I really applaud Dr. Lindsey for being so forthright about how NeoGraft is being pushed on unqualified docs. I've talked to numerous guys who think there is some inherent value to NeoGraft--as if the technology magically provides the best results. One person I know SOUGHT OUT a NeoGraft procedure just because he believed it was the cutting edge. Their branding has been so effective that lots of consumers think that NeoGraft is its own unique type of procedure rather than just a graft excision tool for FUE. Same goes for ARTAS, but probably to a lesser extent.

[Petchski]

So that's how it happens, Neograft's sales reps smooth talking B.S, selling to docs that this can increase your profits by x y z. But still, shame on the docs who take up the offer cos it's pretty arrogant to think that with next to no experience you can just dial in successful hair transplants with some mercenary techs, not to mention just taking the word of a sales rep.

 

What could go wrong?

 

ps I've also noticed posters coming on this forum all hyped up about the Neograft, clearly just read some PR guff and swallowed it all hook, line and sinker.

[Dr. William Lindsey]

I've stated this MANY times. IF and when I can buy a machine that won't get pregnant, gall stones, divorced, have a bad day, feel bad, bitch gripe or complain, yet still does the quality job my cutters do...I'll buy it no matter the money cost.

 

When Wendy(my lead tech) and I got invited to a neograft demo a few years ago, run by a facial plastic surgeon (like me, same age, same fellowship year but different institution), we both had visions of firing the other techs and counting the saved money.... THEN I put on my loupes and saw the sucked out roots and we left.

 

It may work for some people but should not be considered a "profit center" in a non hair doctor's office. Hair is not rocket science but just needs attention to detail, and consistency to work pretty well, most of the time. Take away attention to detail and experience in any medical venture and trouble often follows.

 

Dr. Lindsey McLean VA