How much should graft count figure into procedure chosen?

[esrec]

Two other things to note: the picture with the crown featured does contain my full masked routine. My crown is full but overall coverage is deceiving.

 

Also, the tanline on my forehead shows the area I currently mask but you can see the fuzz much lower, where my harline used to be. Fortunately a widows peak allowed for the line to recede simply to where the rest of my hairline lives.

[Melvin- Admin]

Cost is not factoring into my decision. Im thankful to have some flexibility there. I mean that in the most respectful way.

 

I think I came into the process thinking the narrative was more clear--short hair, dont want scar, ok with 80% effectiveness--go FUE, dont mind scar care about hair quality/yield, still with FUT.

 

Since updating my research over the past month, it seems as that story has become more blurred, if even now in a positive way.

 

This narrative is still around especially with physicians that are more comfortable performing FUT, that's why I encourage you to speak to a physician that is good at both, they will tell you that the difference in yield is insignificant. Personally, I believe them more than a physician who primarily practices FUT because they don't have an agenda, my surgeon Dr. Diep, is a recommended surgeon here, he's got amazing results with FUT and FUE when I consulted with him and asked him about my apprehension regarding yield, he advised me that he was an FUE specialist therefore he was confident his yield would not differ on either procedure but he told me it was up to me he could do either procedure and get good results. I think nowadays it's more important the surgeon you choose rather than the procedure itself know what I mean.

 

I just saw your pics, your hairloss is very minor, 1,800 grafts would be good on the temples, I think 2,000 would really give you excellent density, but 1,800 is ok for your minor hairloss.

[newbie33]

Esrec,

 

As you've probably noticed, you will receive differing opinions on this matter.

 

I'm sure you want all the information you can get, so I'll give you mine as well:

 

For a case of this size, I think you'll see better results from FUT opposed to FUE. Though people do disagree on the yield issue, the available data shows that there is more of a difference than we'd probably like there to be. Check out this study done by Dr Beehner (a Coalition doctor here):

 

 

What he did in this study was compare skeletonized (FUE) grafts to "medium/chubby" (FUT) grafts and evaluated survival (and, therefore, yield).

 

As you can see, the differences were statistically significant.

 

If you do still want to do this as an FUE, you may want to look into breaking the procedure up into two smaller parts. I think most agree that the best procedural technique and overall outcomes with FUE are achieved when really only dealing with a small number of grafts daily.

 

Good luck with your research. Hopefully this adds a bit of a different perspective and helps you reach a decision -- be it FUT or FUE.

 

Feel free to ask any additional questions!

 

Not sure I understand that table. Does the 'survival rate' really mean 'growth rate' ? (Surely you can't have an increasing survival rate over time - if the graft survived at 19 months on they must have survived at month 14 too).

 

Also, why are some of the numbers doubled in the right-hand columns I.e 55 grafts then becomes a score of X surviving out of 110. Is that the number of hairs that survived?

[mav23100gunther]

Thanks. How much of this is subjective? Knowing Bernstein pioneered very early on and continues to, and Harris recently received a top surgeon award in created the SAFE method, I'm curious how "2nd tier" these surgeons could be.

 

I understand price factors for many, but for outcomes purposes, I'd like to exclude this in my decision.

 

You just don't see a lot of patient reviews or patient postings for these surgeons. Just do some Internet searches of those two, and compare to searches on Hasson & Wong or Rahal. Also compare the pictures, you will see a much higher quantity of patients from H&W, Rahal, or Shapiro as well as more wow results. Bernstein is also too conservative and I don't believe he even does mega-sessions. He may be an early pioneer, but in my opinion, he isn't in the same class as the surgeons I mentioned.

[Swooping]

Thank you, also good perspective.

 

I don't wear my hair short, but do care about a scar, but not nearly as much as I care about quality of outcome. It sounds like, even within the debate, that at this stage, an expert FUE surgeon can produce long term results/benefit with FUE that can match FUT. The intangibles then take over once youve nailed the surgeon.

I'll post pics now.

 

Well said. I concur. You don't want the linear scar too as many people don't (who does? lol), so it should be clear for you. Keep a sharp eye. Look for independent patient results too.

 

HTSoon makes some goods points by the way !

[esrec]

You just don't see a lot of patient reviews or patient postings for these surgeons. Just do some Internet searches of those two, and compare to searches on Hasson & Wong or Rahal. Also compare the pictures, you will see a much higher quantity of patients from H&W, Rahal, or Shapiro as well as more wow results. Bernstein is also too conservative and I don't believe he even does mega-sessions. He may be an early pioneer, but in my opinion, he isn't in the same class as the surgeons I mentioned.

 

I kinda have to disagree with you here, quite strongly. While it's nice to have surgeons take time out of their busy day to contribute on this forum, it would be questionable advice and ultimately baseless to select a doctor based on their participation and contributions here.

 

While we love their feed and and evidence of impactful results is a plus I would be concerned by those who select a surgeon based on that. By that standard any doctor who participates and posts pictures in this particular forum is good and those who do not, aren't.

 

To that point, what about all the patients that haven't decided to come to this very forum for advice? What about their results and feedback? How many great doctors do we not even know about because they have a healthy practice, that frankly, allows them to flourish without having to "log on" and thought share with us.

 

I agree to gather as many opinions and facts as possible but am wary of drawing conclusions and legitimizing surgeons based on forum feedback and activity.

 

Frankly, I'd prefer my future surgeon is busy to the point where he cant afford to spend time posting on a forum and instead is busy with patients. The crowd here has been absolutely invaluable so far, but lets demonstrate some caution with our statements as well. This is a big decision for all of us.

[KO]

"It sounds like, even within the debate, that at this stage, an expert FUE surgeon can produce long term results/benefit with FUE that can match FUT."

 

I think this is untrue, top FUE guys cannot match FUT results (Note you compare top FUE guys to the general FUT pool, not top FUT guys like H&W). However, your case is so small, it doesn't make any sense to cut your head open. If you were a NW4+, then you'd have a decision on your hands. Just go FUE and run with it.

 

That said, there are guys who have gotten great FUT work done for smaller sessions than yours. Take Spanker for example. But that is all academic.

[mav23100gunther]

I kinda have to disagree with you here, quite strongly. While it's nice to have surgeons take time out of their busy day to contribute on this forum, it would be questionable advice and ultimately baseless to select a doctor based on their participation and contributions here.

 

While we love their feed and and evidence of impactful results is a plus I would be concerned by those who select a surgeon based on that. By that standard any doctor who participates and posts pictures in this particular forum is good and those who do not, aren't.

 

To that point, what about all the patients that haven't decided to come to this very forum for advice? What about their results and feedback? How many great doctors do we not even know about because they have a healthy practice, that frankly, allows them to flourish without having to "log on" and thought share with us.

 

I agree to gather as many opinions and facts as possible but am wary of drawing conclusions and legitimizing surgeons based on forum feedback and activity.

 

Frankly, I'd prefer my future surgeon is busy to the point where he cant afford to spend time posting on a forum and instead is busy with patients. The crowd here has been absolutely invaluable so far, but lets demonstrate some caution with our statements as well. This is a big decision for all of us.

 

I wasn't talking about the doctor contributing to this forum, I really was talking about reviews and posting from patients themselves. The lack of participation and reviews from patients on the web (not just this forum) compared to other surgeons should be telling. I agree, it may not mean he is a bad surgeon, but should be a datapoint for you to consider. I also never said Bernstein was a bad surgeon, he wouldn't be recommended here if he were. In fact he may in fact be a great surgeon, but based on my own countless hours of research which included consulting with Bernstein himself and comparing at thousands of pictures from him and other surgeons, my own conclusion was that there is a small group of surgeons who appear to be producing outstanding results on a consistent basis, and then a second group of surgeons who I consider to be tier two who are good as well, but are just not in the same class. In addition, whenever I consulted with surgeons themselves, I always asked them who they consider to be there strongest competition, and guess which names came up almost every time? Hasson, Rahal, Shapiro, Erdogan, Feriduni, lorenzo, and even Feller. I consulted with a lot of surgeons by the way. Also do a google search on best HT surgeons in the world, and see which names forum members consistently mention. Once again, it is subjective, but Bernstein's name just doesn't come up. It is also just my opinion, you really should do your own research, and make sure you look at plenty of patient pictures when you visit his clinic. It should become obvious. It's also your own head, so why wouldn't you want to go with the best of the best? For my 1st procedure, I elected to go with one of the tier 2 surgeons, and my results were solid, but less than stellar. Therefore I am going to go for a 2nd pass with one of the elite surgeons. Everyday I regret not having gone with one of the elite. Finally, no disrespect to you, but in the words of our old friend Busa - "it seems you have a lot of research to do before you are ready to get a HT".

[esrec]

I wasn't talking about the doctor contributing to this forum, I really was talking about reviews and posting from patients themselves. The lack of participation and reviews from patients on the web (not just this forum) compared to other surgeons should be telling. I agree, it may not mean he is a bad surgeon, but should be a datapoint for you to consider. I also never said Bernstein was a bad surgeon, he wouldn't be recommended here if he were. In fact he may in fact be a great surgeon, but based on my own countless hours of research which included consulting with Bernstein himself and comparing at thousands of pictures from him and other surgeons, my own conclusion was that there is a small group of surgeons who appear to be producing outstanding results on a consistent basis, and then a second group of surgeons who I consider to be tier two who are good as well, but are just not in the same class. In addition, whenever I consulted with surgeons themselves, I always asked them who they consider to be there strongest competition, and guess which names came up almost every time? Hasson, Rahal, Shapiro, Erdogan, Feriduni, lorenzo, and even Feller. I consulted with a lot of surgeons by the way. Also do a google search on best HT surgeons in the world, and see which names forum members consistently mention. Once again, it is subjective, but Bernstein's name just doesn't come up. It is also just my opinion, you really should do your own research, and make sure you look at plenty of patient pictures when you visit his clinic. It should become obvious. It's also your own head, so why wouldn't you want to go with the best of the best? For my 1st procedure, I elected to go with one of the tier 2 surgeons, and my results were solid, but less than stellar. Therefore I am going to go for a 2nd pass with one of the elite surgeons. Everyday I regret not having gone with one of the elite. Finally, no disrespect to you, but in the words of our old friend Busa - "it seems you have a lot of research to do before you are ready to get a HT".

 

Tremendous words. Thank you so much. I hope my note didnt come off too strong, I was only pointing to the lack of correlation between activity and even posting patient reviews and success. I thought I had done a ton of homework, but my homework has clearly skewed toward the nuances of each procedure. Thank you for the candor.

 

Bernstein: His history is what attracted me to him, and being based in NY. His bedsides manner and demeanor leaves much to be desired, but its also the kind of temperament that suggests extreme confidence and comfort---qualities I do want in my surgeon. Admittedly, even as a NY'er who appreciates the dry manner and wit, extracting answers from him has been a challenge. He is confident, short, and direct about his direction that I should have FUT. He seems "safe".

 

Harris: I saw he was the recipient of the Follicle award and he was advancing FUE techniques with the SAFE system. These felt like compelling factors and a strong reason to add him to the consideration, particularly if considering FUE: http://www.hairrestorationnetwork.com/eve/177464-dr-james-harris-honored-2014-golden-follicle-award.html

 

He's been very fair in both of my consultations, not trying to sway me in either direction but delivering confidence that concerns about "messing this up" by choosing the wrong procedure is much less a factor, rather, the surgeon. He's provided a ton of info and do feel drawn to him.

 

Shapiro: I've consulted with Jeffrey Shapiro (not sure if theres more than one) he has also given me a ton of detail. He doesnt focus on just hair which for me is a big detractor, but has been a voice that has level set some of the opposing opinions that the other two seem to share.

 

I should probably post pictures in a new thread.

[mav23100gunther]

Tremendous words. Thank you so much. I hope my note didnt come off too strong, I was only pointing to the lack of correlation between activity and even posting patient reviews and success. I thought I had done a ton of homework, but my homework has clearly skewed toward the nuances of each procedure. Thank you for the candor.

 

Bernstein: His history is what attracted me to him, and being based in NY. His bedsides manner and demeanor leaves much to be desired, but its also the kind of temperament that suggests extreme confidence and comfort---qualities I do want in my surgeon. Admittedly, even as a NY'er who appreciates the dry manner and wit, extracting answers from him has been a challenge. He is confident, short, and direct about his direction that I should have FUT. He seems "safe".

 

Harris: I saw he was the recipient of the Follicle award and he was advancing FUE techniques with the SAFE system. These felt like compelling factors and a strong reason to add him to the consideration, particularly if considering FUE: http://www.hairrestorationnetwork.com/eve/177464-dr-james-harris-honored-2014-golden-follicle-award.html

 

He's been very fair in both of my consultations, not trying to sway me in either direction but delivering confidence that concerns about "messing this up" by choosing the wrong procedure is much less a factor, rather, the surgeon. He's provided a ton of info and do feel drawn to him.

 

Shapiro: I've consulted with Jeffrey Shapiro (not sure if theres more than one) he has also given me a ton of detail. He doesnt focus on just hair which for me is a big detractor, but has been a voice that has level set some of the opposing opinions that the other two seem to share.

 

I should probably post pictures in a new thread.

 

Buddy, I was in the same boat as you. I live in New York, and therefore limited my options to surgeons in New York for the first pass. It was a huge mistake on my part, and the reality is that the best of the best elite surgeons are just not here. Don't get me wrong, Dorin, Wesley, Feller, and Bernstein are the top surgeons in the NY area, but I would say that out of that group, Feller is probably the best in my opinion but I still think they are all tier two. What I did notice is that Bernstein has a couple of weeks long waitlist for a consultation, and his office was packed when I visited. I did think he was very professional, and looks like someone who would be a safe bet, but... when I was waiting for that half/ hour in the waitroom I paged through an album of pictures of his patients, and they really did not blow me away at all. As I said before, his price per graft is ridiculously expensive, and I do not think its justifiable unless you believe he is the best surgeon in the world. Only Feriduni or Hasson could justify that kind of price, and they are way cheaper. I know you think he is a safe bet, but do some more research of the guys I listed.

 

The Shapiro I was referring to is Dr Ron Shapiro - not to be confused with Jeffery. Dr Ron owns Shapiro medical group in Minnesota, and I think he is the safe bet you are looking for. At a min, compare his history against Bernsteins, and then you will know what I am talking about. His patient rep Matt Z is also awesome, well worth the consult. Good luck mate, and let me know if you want more advice from me offline

[mav23100gunther]

Also wanted to point out that Dr Bernstein still uses the Artis Robot for FUE procedures whilst the top FUE surgeons and Rahal have discontinued its use citing that its not as effective of a manual process. Not sure if it means much, but another datapoint.

[win200]

Also wanted to point out that Dr Bernstein still uses the Artis Robot for FUE procedures whilst the top FUE surgeons and Rahal have discontinued its use citing that its not as effective of a manual process. Not sure if it means much, but another datapoint.

 

I would never let someone use the ARTAS robot on me. Never.

[esrec]

I just sent a note to H+W in the time we've been going back and forth. The advice here is extremely valued.

 

Has anyone had experience with Dr. Harris? He's admittedly intriguing even without participation. Recipient of a very prestigious award in 2014, invented the SAFE method, moving pretty aggressively on the FUE front. Also his office (not an indicator alone) is very backed up. As an aside, hes incredibly responsive by email. 24 hrs or less and detailed in all responses.

[Dr. Alan Feller]

I think you mean FUT can harvest more grafts in a single sitting, when you say yield you're talking about the growth of the grafts, it's a hotly debated topic on here, but in my opinion the difference in yield via FUE vs FUT is insignificant, 1,800 grafts is relatively small for FUT, not sure why you'd want to do so little grafts with FUT, even for hairlines typically 2,000-2,500 is a good amount.

 

I must disagree with this on two levels.

 

The first is that the difference in yield via FUE vs FUT CAN be insignificant, but more often than not is NOT insignificant. This is the unabashed truth regardless of internet FUE hype and explains the second point:

 

The second is that while FUE may need 2,000 to 2500 grafts to achieve a significant cosmetic difference on the hairline as mentioned, FUT can do it with less far more often because there is no need to overload the area to compensate for a lower yield.

 

Here are the results of a patient I did FUT on years ago. I just picked these photos off his own blog just now. Look at what 1800 grafts of FUT can do. It is hardly insignificant, and this patient's hair is anything but thick. He has classic thin and silky hair.