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Dr.Thomas Rosanelli

FUE ARTAS 1,837 grafts done over one session with Dr. Rosanelli

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On-the-one-hand I agree with the mods, it’s not necessary to joke about a patients mediocre-at-best result as they may be on here as well, being respectful AND critical are NOT mutually exclusive.

On-the-other-hand the results are mediocre-at-best, as seems to be the norm with ARTAS, and it doesn’t help any for prospective patients doing research for a procedure to think that this is an acceptable result especially for the high price, which, I’m willing to bet that clinics and doctors that market it heavily are aiming to recoup the hundreds of thousands of $ they invested in this “high-tech” robot and likely regret it.

So let’s be honest, expecting ARTAS to produce good HT results compared to hands-on human technique and artistry, is like using a Roomba to vacuum your entire home instead of you and a Dyson and expecting a proper cleaning.

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3 hours ago, Bill - Managing Publisher said:

You either don’t know how to read or are an inherent trouble maker.  Didn’t you read what I wrote?  Again I said - 

Now, there are some exceptions to that rule as I’ve seen some pretty impressive results from physician members of our community using some of the fancier machines. But it does go to show that the skill and experience of the surgeon is paramount over the type of device or machine they use. “

if you continue twisting my words or Melvin’s I’m going to assume that you’re here only to stir the pot and poison the well - and we will have to suspend your posting privileges. 

Bill

No I’m not illiterate and I was questioning you on a quote that to me is confusing & contradictory. That said, I also respect & understand there are rules to be adhered to. 

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20 hours ago, Bill - Managing Publisher said:

Guys, since when did this become an elementary school childhood playground? This is a respectable hair restoration forum  created by patients, for patients. And shall I remind everyone that it’s for adults? 

I agree the result presented isn’t one of those “wow“, super impressive results that shakes the earth like we’ve seen from others. However, this particular patient only received 1837 grafts over a diffuse thinning area and frankly, this is exactly what I would expect for this type of procedure and result. 

No, this is not a failure, it is not a bad result or poor growth. It is exactly what anybody should expect from 1837 grafts.  

But what I’m mostly concerned about  is the baiting from JJ towards Melvin into potentially warning someone about their behavior and discussing the possibility of suspension. 

We don’t ban people for sharing their genuine opinions, good or bad. However, I agree with Melvin that it is a sad day when the adult members of this community can’t be respect full when presenting their opinions. 

If I were to post my opinion as a patient member on this particular result, I would say something like the following in a respectful way… 

“To be honest, I’m not overly impressed with these results and I can’t help but wonder why this particular patient only had 1800 grafts considering it’s obvious that he requires more to achieve any real level of fullness and density.   So I’d like to ask the doctor to further explain why only 1800 grafts were transplanted as I’m sure there is a logical explanation for this.”

The above is an example of stating that I’m not real impressed while being respectful and giving the surgeon the benefit of the doubt and even asking why only a small number of grafts were transplanted. 

And then JJ comes along baiting Melvin  as if he would be in the wrong to consider such actions. 

I’ll tell you all now, I appreciate everyone’s genuine opinion and to be honest, I’m not overly wowed by this particular result either. However, not every single result is or will be a homerun as some are simply singles or doubles.   In some cases, patients require more than one procedure to meet their ultimate goals and final results. I suspect a long-term plan was discussed in this particular case and I’m sure the patient knows that if he wants the kind of density and fullness others have achieved that he will need to go back for more.   But that doesn’t make this result of failure. It’s just an intermediate state between procedures. 

 I would expect the veteran members of this community to understand this simple concept however, some of you who are new are or have been spoiled by seeing “wow” results in a single session may not realize that not every patient is going to experience this. 

 For example, my hair transplant journey was a work in progress up until the third session and the fourth session really finished it off. Even still, some may tell me that it’s not perfect because I still have thinning in the crown and above the occipital ridge.  And that’s OK, not everybody has to love my results but… I would expect people to be respectful towards me just as I’m sure this patient would want respect also. And perhaps he is even observing these remarks and if I were him, I’d certainly be discouraged and upset by what people are saying even though he has no reason to be.

Please remember when you are replying, that you aren’t just showing respect for the doctor, but for the actual patient being shown in the results.  

Best wishes,

Bill

Hey bill

im not sure why you’re overly focused on my post as it had nothing to do with the doctor or the results. You brought it up twice in one post so it seems to have made you somewhat heated. I apologize if it came off as “baiting.” The post was meant to add some humor as the whole Melvin and PD interactions seem to all follow a certain trend. If I have broken any forum rules please let me know.

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Part of being an adult is being able to handle criticism. The fact is that ARTAS is a highly inferior method and any surgeon who uses it is acting unethically in my opinion. It should be banned. I feel bad for this patient and any other patient who has been led to believe this is a viable solution. 

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9 hours ago, JeanLDD said:

The problem here isn't just that the result shows virtually no growth or distinction between mutligrafts and singles in the hairline, but rather that the clinic thought it was an acceptable representation of what is achievable as they were the ones that posted it, because its not even close. It is ultimately misleading to potential and current patients, as well as being poor marketing in general.

To pretend that 2000 grafts here grew is plainly dishonest, you can also easily see that there are virtually as many doubles as singles in the hairline:

image.thumb.png.bd039a1f1121a4e54c395f9ddab3b46d.png

image.thumb.png.af21157f1141edf70f4e357d0d84a7ae.png

 

Its not a great deal different in density or approach than old style hair plugs. Aside from the result, the approach is clearly not even in the same universe as the average FUE result of many top FUE surgeons here, Feriduni, Cooley, Erdogan, Hasson/Wong, Rahal etc.

 

Certainly it can be deemed distasteful to criticise a result as it is attached to a person, but presumably if this has been posted here by the clinic they have given permission. More importantly, the forum isn't for the sake of one persons feelings (who quite frankly is better off knowing the truth), but rather future potential patients. If you told a potential patient this is what was an acceptable expected result in terms of cosmetic improvement, virtually no one would have hair transplants. Everyone is aware of the problems of the ARTAS, a standardised approach that still has countless examples (the majority I see on here) that are below par, overly large punch sizes, serious issues with donor depletion and scarring, lack of natural appearing irregularity in extraction area etc.

 

I can virtually guarantee that even if you offered to PAY the admins or any top posters here $5000 to have a 1500+  graft procedure with the ARTAS they wouldn't do it. The reality is that results like this are give a bad rep to other surgeons on the network also. For exclusivity and ideal of state of the art hair transplantation to be maintained in the forums recommendations, it should live up to that. I guarantee many potential doctors that might want to be represented here would be put off by a result like this by a recommended surgeon, it goes well beyond just a poor yield.

Jean, 

Thank you for this well thought out post, I certainly don’t want posters to think I dont want anything negative to be said of a result, that’s ridiculous. Your post highlights some real concerns with the result and I have to say I agree with some of your concerns as well. 

I will reach out to Dr. Rosanelli and ask him to respond to some of these issues on the thread. 

Also, constructive criticism and being flat out rude are two different things. Sharing negative opinions of a result and being respectful are not mutually exclusive. Now I’m not saying this specifically to you Jean, I’m speaking in general for readers and other posters. 

In fact, I encourage posts that are well thought out and point to specific issues with the results. In order for the community to flourish we need to encourage discussions. This forum shouldn’t be looked at like a YouTube comment section. This forum will never grow or entice others to share their experiences if we encourage posts like “joke of a result” or “sucky results” come on guys we’re not fourth graders.


I do not provide medical advice, recommendations, all responses are my opinion.

Melvin- Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @htrestoration FacebookPintrest, Linkedin and YouTube.

 

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If possible, I think it would be very helpful if the Doctor could post some photos of the donor area after extraction on the day of the HT.

Also common sense would say (unless it was an unusual case which this is not) the Dr would post only his best results  / or results he was proud of here on the forum.

If I was a potential client, I would be thinking rightly or wrongly if this is one of his best results what does his worse results look like...

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BACKGROUND:

Sorry for delayed response but I was not back in the office until January 3rd, and I wanted to review this patient’s chart prior to responding. I appreciate your comments and would like to sincerely address them based on my practice which has been dedicated to hair replacement for over 30 years.  That said, I regret not posting background and details to put results in context

First, I would like to mention some of the factors which I take into consideration and which I will attempt to address with future postings for this readership. 

·         What are the patient’s desires?

·         What density is he looking for?

·         Age and family history and probably future loss?

·         Does the patient understand the pros and cons of each technique actually prefer a FUE or FUT based on personal preference?

·         Does the patient want to do several sessions for gradual replacement or a one and done? (This varies greatly from patient to patient-and there are many patients who look for a very slow increase in order to keep others from knowing they are having surgery)

·         Is he willing to commit to other non-surgical treatments such as minoxidil, finasteride, PRP, Exosomes, LLLT?

This is just part of the discussion I personally have with every patient in consultation before surgery (I do not use consultants to meet with the patients so they have all their concerns addressed by me well before they even decide to go forward with surgery).

 

THIS PATIENT:

Based on the health and family history of this young patient, there is a significant risk of future hair loss.  He had reasonable expectations and was not trying to get back the hairline he had at 15.  He wanted a gradual change, minimal grafts to increase his density, which would allow him to decide in the future if he wanted more density in front versus additional grafts mid-scalp or for potential future areas of loss. 

His choice was to have at least one additional surgery in 1 to 2 years for hairline advancement and refinement rather than have a more extensive surgery at this time.  I supported his choice as it is my policy to not over harvest the donor which is unfortunately very common in FUE procedures-not withstanding hand device, U graft, Alpha graft, ARTAS, Neo graft, etc.

In this patient a second session of 1,000-1400 grafts (based on his finances and desired result) will be placed with the “current hairline” buried .8-1.2 cm behind the single hair “new” future hairline. The use of some multi hair follicular units along a “Current HL” will add some needed visual density to the “newer” hairline that IS IN FRONT of this current hair line.

In addition, the use of the second session grafts can be distributed in appropriate numbers to create a more anterior natural hairline. Then the extra grafts can be used to add density to front or mid-scalp.

 

THE TRUTH ABOUT FUE:

 FUE is an adamant preference for some patients.  They should be totally educated on the pros and cons of the procedure-its benefits and limitations.  Whether a physician uses ARTAS, Cole punches, SafeSystem, U System, neograft, etc. does not reflect on the doctor’s ability or result. Many physicians use one or more of these systems effectively and efficiently.

One of the big negatives of FUE is the tendency of the physician to “Cherry Pick” the better-quality grafts. This in and of itself leads to a depleted donor. I have seen many patients and many different techniques used for FUE. No matter which system/ method may have been used, depleted donor due to overharvesting can and does occur. Doing sessions of 3,000-4,000 grafts FUE for hairline and frontal areas in patients that are younger may lead to depleted donor long term. The advantage of large sessions in achieving a higher density and fuller hairline can lead to less grafts available for treatment of mid scalp and upper crown. Unfortunately, some doctors regardless of experience, actually purposefully harvest into the donor fringe to achieve a short term 10-15 year “better result” at the expense of a 60+ year old with visible scars and thinning of the original HT surgery. The advantage of the multiple future session donor harvest allows for faster healing, less scarring, and also re-evaluation of the donor and the grafted area for best use of a limited resource.

 

MY BELIEF:

I have 30+ years of experience and have seen many of my own and other physicians HT patients who have 20-30 years post treatment hair loss. Any truly knowledgeable HT surgeon that believes they can overharvest and over treat balding patients between ages 25-40 with no long-term consequences is just delusional. A cautious approach with less grafts and more thought-out long-term plan can always get more detailed results that are tailored by patient’s desires and need, rather than get in, get done, and get their money. I do all my own consults and all my patients are informed of my techniques, methods, and long-term plan. Some of these consults decide they want a much larger session (One and Done) and then take themselves elsewhere, and that is fine. I have seen some of these patients that still come back to us for their non-surgical hair needs and some may have fine results. I have also seen many that come back 2-5 years later with depleted donor and terrible results and say they wish they had been more conservative and less aggressive.

 

CAVEAT:

Many of the comments as to FUE devices and HT surgery being marketed to non –hair restoration physicians are appropriate.  These physicians are not knowledgeable in hair (even if otherwise great plastic surgeons) and have “hired guns” come in and sometimes do the surgery with disastrous results. 

  • Thanks 2

Dr. Thomas Rosanelli

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Thanks for taking your time responding doctor .. we understand your conservative Approach ..  but with your 30 years of experience ,, you should Already know that  hands on approach performed by the doctor will achieve a much better result .. you should of talked the patient out of doing the Artas....the results speak for themselves . Don’t you think you would of achieved a better result  using those  1800 grafts , instead of the artas.. 

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Posted (edited)

Hey Legend!

This patient has extremely fine/thin-caliber hair w/a big skin/hair-color contrast and a massive family history of alot of balding.

He's going to be a NW5+ or NW6 - so it really doesn't matter if he wants to proceed slowly over time. 

If his Artas harvested grafts survived just like other FUE extraction methods - what difference does it make?

I think Artas even has small mm punches now - down to .7 and .8mm.  I recall Arocha, H&W and other top clinics buying the machine - although I think they realized eventually it was ALOT more work for them in the long run than extracting via mechanized fue punches (AROCHA) or manual w/technicians doing the work (H&W).

Also, this doctor is showing a small procedure on a guy w/alot of balding already and less-than desirable hair characteristics - so apples to apples I always say.

Many of the smaller FUE procedures we see on this site are very young guys w/'in-their 20's' hair qualities and superior donor quality and very exceptional hair characteristics (caliber and wave).

I would consider Dr. Rosanelli a 'boutique' surgeon - and I bet he does too.  His career is based on conservative work that he feels should hold up 20-30+ years over time.  I am sure alot of his clients are high-net worth and even if you are worth mid 7 figures and have a family history of alot of balding and you hit your 50's and 60's, if you went HUGE young and blew out your donor, with the progressive nature of hairloss that intensifies as one gets older (40+) - those guys don't want to have to explain visible excessive fue scarring and would rather be a bit more subtle in the way they present their hair restoration surgery over the decades.

I don't think alot of young guys understand that completely.  Dr. Rosanelli's primary client base is most likely the wealthiest guys of N. California fwiw.  I understand the doctor's attitude towards erring on the side of caution and believe it or not alot of guys that are subtle don't mind smaller surgeries just so that virtually no one will ever know. 

In high-net worth society and corporate life - just the stigma of noticeable plastic surgery/hair restoration can trickle down and these types of guys are trying to avoid that (methinks) as much as possible.  A complete 5000 graft or mega-session w/a funky shaved head and downtime for many of these guys - it simply can't happen.  Too much $$$ on the line imho.  Many probably won't allow the appearance of excessive vanity - people that work w/and under them could use it against them.

I consult (work only-in person quarterly) w/alot of high-power attorneys in South Florida, East Coast & some from Israel and China.  Not a single one of them would ever consider having a large procedure at one time.  Two of them are using the incremental approach over time very discreetly. 

Since I have had many surgeries but do NOT interact day-to-day in an office setting nor do I have a social circle of high-net worth friends; a few of the attorney's ask me in great detail about what I've done over the last 29 years - but really aren't considering a cosmetic procedure seriously.

Normal everyday Joe types - it doesn't effect them quite so much in terms of sheer economics & a upper-echelon social circle.  Of course some guys overcome bad work (ALOT do) and just say screw it and live their lives w/bad work regardless.

Just my perspective.

Edited by jjsrader

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Posted (edited)

I think accusing surgeon using  Artas as unethical is ridiculous. Producing mediocre results does not make a surgeon unethical as there has to be poor and mediocre ones in order for there to be great ones.

Granted you could make an argument that Artas results are not good enough to be recommended surgeon. And though this result is not he worst I’ve seen from recommended surgeon. It’s on the lower end for sure. Atleast the way it was presented.

Though the greatest number I’ve seen is from scott alexander and has a decent number of good to great results... granted he doesn’t use Artas for incisions. Maybe I’m losing my own argument and in talking in circles :P

 

Edited by here

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