If you transplant now, what will the next 20+ years look like?

[Melvin- Admin]

8 hours ago, bismarck said:

Looking at Joe Biden and Trump has made me legitimately reconsider my whole transplant philosophy. What a pair of Bosley disasters.

Joe Biden used to look way worse, he had the worst hair plugs I’ve ever seen. Trump on the other hand had a fleming meyer flap procedure. 

[bismarck]

They both look horrible to me. Look at Biden without filler/concealer -- he literally looks like a burn victim.

[Melvin- Admin]

17 hours ago, indymusician said:

OP here - I appreciate everyone's thoughts so far.  This fear of the unknown is scary.  I had no reservations at all back when I did my crown transplant 5 years ago - but i hadn't had any noticeable loss anywhere else (and at 38, I thought I might be in the clear).  Now, my thoughts are:

• If I use more grafts for my crown (which likely only has the 1500 grafts from the previous transplant), am I wasting them? I mean - if I have just 2500 grafts there at the end of the day, I'd still need Toppik I suspect.
• I have thick donor, so maybe the above doesn't matter - but I keep going back and forth on that....
• What if I lose all the frontal hair (like Mike and Micky in my first post) - if I only have transplants, won't it look bizarre? How many would I need to not look bizarre?
• Am I risking permanent loss of native hairs in the front (and the previously transplanted hairs in the crown) by doing a new procedure?
• So, maybe I should never touch the front and let if be natural?
• Why don't we ever see many people 10, 20 years later from having their transplant?

I guess the fear boils down to - if I start touching the front, it's permanent - though it might look great the next 5 - 10 years. Heck, it might look great the rest of my life - but it also might look like Joe Biden's.  Sigh - how do others get around this in their head? Just say YOLO and take the plunge?  

Can you post pictures? There are some men who only lose hair in the crown. For those men, having multiple procedures to treat the crown is okay. 

You’re comparing Joe Biden who had hair plugs in the 70’s to today, there’s no comparison. The reason why you don’t see that many long term cases is because realistically most men don’t ever want to admit they had surgery. @Pat - Community Publisher had his procedures almost 20 years ago, and he still looks great. I created a video on our former managing publisher Bill, he had his procedures over 16 years ago. 

I understand the apprehension, but carefully planning your procedures and using your donor supply well, is far from YOLO. 

[indymusician]

2 hours ago, Melvin-Moderator said:

@Pat - Community Publisher had his procedures almost 20 years ago, and he still looks great. I created a video on our former managing publisher Bill, he had his procedures over 16 years ago. 

How many grafts in each session? How many did he have to the crown vs elsewhere?

[Al - Moderator]

10 hours ago, indymusician said:

How many grafts in each session? How many did he have to the crown vs elsewhere?

If I remember correctly, Bill had 9600 grafts over 4 sessions. I'm not 100% sure I'm remembering it correctly though.

 

[Al - Moderator]

14 hours ago, bismarck said:

They both look horrible to me. Look at Biden without filler/concealer -- he literally looks like a burn victim.

 

You can't go by Biden or Trump because they were both done so many years ago when nothing near the current technology was available. I don't think Biden is using any type of filler or concealer. I just think he had some revisions over the years as procedures improved. My first hair transplant was 31 years ago using 3.75mm grafts cut from a strip. The FUT strip was new and had just started being used. I had to pay extra for that option. Prior to that they would take out 4mm plugs from the back and place those in the front. That was the standard for the time. They used a triple blade knife to remove the strip with no care at all about graft transection during the strip removal. The results of that time don't look anywhere near what a modern hair transplant looks like.

 

[Melvin- Admin]

17 hours ago, indymusician said:

How many grafts in each session? How many did he have to the crown vs elsewhere?

I don’t recall for Pat, I believe he’s had around 1,800 in the crown, but I could be wrong. In total I believe he’s around 3,800 grafts. Remember, in the early 2000’s sessions of 2,000 grafts were considered mega sessions. That’s why I’m saying comparing results, even from twenty years ago is not fair. Life is progressive, in science, medicine etc, advancements are made, and hair transplantation is no different.

The tools, the methods have been refined over the years, and they will continue to be refined. Hell, even in the past 6 years since I had my procedure I’ve seen FUE really expand and become a viable option. When I starter researching few American doctors did FUE on a big scale, that’s changed, in just 6 years. If I’m thinking long term, I’m almost positive surgeries will continue to get better, and the donor will be able to harvested with minimal scarring and maximum grafts. 

[bismarck]

That's an interesting point as well. If the procedure is getting better each year, that would also support waiting if your situation is not urgent.

Edited April 9, 2020 by bismarck

[Melvin- Admin]

1 minute ago, bismarck said:

The procedures have advanced but I don't think two years is reasonable. Seems to have plateaued since ~2012.

I meant twenty, but it’s definitely changed a lot since 2012, back then no American surgeons did FUE, and the ones that did could only do around 800 grafts per day. Now, in 2020, Dr. Hasson among others can do 3,500 in one day with good results. In those days, strip was king. 

[bismarck]

14 minutes ago, Melvin-Moderator said:

I meant twenty, but it’s definitely changed a lot since 2012, back then no American surgeons did FUE, and the ones that did could only do around 800 grafts per day. Now, in 2020, Dr. Hasson among others can do 3,500 in one day with good results. In those days, strip was king. 

If things had evolved this would make me even more hesitant to move forward in light of the OP's original point.

But do you think things really have changed that much? Yes, the USA does more FUE now but that wasn't due to innovation but rather following the example of Europe. I don't think there have been any major advancements in hair loss for quite some time unfortunately. In some aspects it may have even gone backwards (ie. the tech mills).

Edited April 9, 2020 by bismarck

[Melvin- Admin]

24 minutes ago, bismarck said:

If things had evolved this would make me even more hesitant to move forward in light of the OP's original point.

But do you think things really have changed that much? Yes, the USA does more FUE now but that wasn't due to innovation but rather following the example of Europe. I don't think there have been any major advancements in hair loss for quite some time unfortunately. In some aspects it may have even gone backwards (ie. the tech mills).

In terms of medicinal treatment no. Things haven’t improved in over 20 years. However, in terms of surgical refinement absolutely. FUE in present form has been around since 2002, it continues to evolve and refine each year. With the size of the punches getting smaller, surgical sessions getting larger, and the growth rates most importantly increasing.

The argument of FUT vs FUE was a valid argument in 2014, many of the surgeons who primarily performed strip conceded the growth rates were significantly lower with FUE. Today, those same surgeons will tell you the growth rates are about equal. In my opinion, that’s an advancement.  

Some say that European surgeons were ahead of the curve, and that may be true to some extent, but even European surgeons have continued to evolve their skill. 

[bismarck]

On 4/7/2020 at 7:48 PM, indymusician said:

Today, those same surgeons will tell you the growth rates are about equal. In my opinion, that’s an advancement. 

I don't think the FUE vs FUT debate as far as yield is anywhere close to settled. Many of the elite surgeons on here still actively disagree. I have yet to see a surgeon come out against the procedure they themselves offer, so I suspect marketing bias has a large role. As you know, there are no well done studies comparing the two.

I also think "FUE and FUT" as opposed to "FUE vs FUT" is a rose-colored distinction. For most, it is a very much VERSUS question.

Edited April 9, 2020 by bismarck

[Melvin- Admin]

1 hour ago, bismarck said:

I don't think the FUE vs FUT debate as far as yield is anywhere close to settled. Many of the elite surgeons on here still actively disagree. I have yet to see a surgeon come out against the procedure they themselves offer, so I suspect marketing bias has a large role. As you know, there are no well done studies comparing the two.

I also think "FUE and FUT" as opposed to "FUE vs FUT" is a rose-colored distinction. For most, it is a very much VERSUS question.

The same could be said the other way, the only surgeons who bashed FUE, were the ones who don't perform FUE on a large scale. Trust me, I've been here long enough to see the shift, not only in the philosophies but in the results. It's not a versus to me, because at some point, I think even those who chose FUT in the beginning will benefit from FUE at some point down the line. So you see, both procedures have their benefits, and at some point most patients will benefit from both.

[bismarck]

I appreciate your opinion and experience though certainly I see it differently. Time will tell.

[gillenator]

Biden not only had his horrendous plugs thinned out, I believe he had more grafts added with updated grafting methods.

[bismarck]

On 4/9/2020 at 12:32 PM, Melvin-Moderator said:

The same could be said the other way, the only surgeons who bashed FUE, were the ones who don't perform FUE on a large scale. Trust me, I've been here long enough to see the shift, not only in the philosophies but in the results. It's not a versus to me, because at some point, I think even those who chose FUT in the beginning will benefit from FUE at some point down the line. So you see, both procedures have their benefits, and at some point most patients will benefit from both.

I disagree. Of course it is often FUE (OR) FUT not FUE (AND) FUT for many.

FUE is a horrible idea for some people, FUT is a horrible idea for others. Specifically some people would be better off starting with strip as it provides a higher lifetime yield of follicles. Others would be better with FUE because they are hoping their native hairs will last or they don't mind a shaved head with pockmarks.

Perhaps your bias is due to your mostly focusing on cases here and not looking across forums, but trust me: FUE failures are a lot more common than FUT. I judge a "failure" as one that both the patient themselves and the community believes to be a poor result. Of course this is limited by picture quality, patient age/medication/scalp character, etc. but it is consistent.

This is undeniable and has not changed in the last 8 years. In some parts of the world, Turkey in particular, it has gotten significantly worse. This does not suggest surgical techniques are advancing, but decaying in favor of medical tourism and chop shops. I do not make this statement lightly--it is based on the cases I've accumulated and catalogued over the past decade from the 7 major hair loss forums, and it is unequivocally true based on my numbers. I would be happy to publish the actual data I've collected, it would be pretty eye opening for many I think. Perhaps one day the yields of Lorenzo and Couto will be seen across the industry, but we are not there yet.

48 minutes ago, gillenator said:

Biden not only had his horrendous plugs thinned out, I believe he had more grafts added with updated grafting methods.

He certainly had his procedures revised. I'm going to try and find a current pic of him without filler to show what I mean. I'm thinking of a recent interview where his scalp looked like elbow skin.

Edited April 10, 2020 by bismarck

[Melvin- Admin]

On 4/10/2020 at 1:13 PM, bismarck said:

I disagree. Of course it is often FUE (OR) FUT not FUE (AND) FUT for many.

FUE is a horrible idea for some people, FUT is a horrible idea for others. Specifically some people would be better off starting with strip as it provides a higher lifetime yield of follicles. Others would be better with FUE because they are hoping their native hairs will last or they don't mind a shaved head with pockmarks.

Perhaps your bias is due to your mostly focusing on cases here and not looking across forums, but trust me: FUE failures are a lot more common than FUT. I judge a "failure" as one that both the patient themselves and the community believes to be a poor result. Of course this is limited by picture quality, patient age/medication/scalp character, etc. but it is consistent.

This is undeniable and has not changed in the last 8 years. In some parts of the world, Turkey in particular, it has gotten significantly worse. This does not suggest surgical techniques are advancing, but decaying in favor of medical tourism and chop shops. I do not make this statement lightly--it is based on the cases I've accumulated and catalogued over the past decade from the 7 major hair loss forums, and it is unequivocally true based on my numbers. I would be happy to publish the actual data I've collected, it would be pretty eye opening for many I think. Perhaps one day the yields of Lorenzo and Couto will be seen across the industry, but we are not there yet.

He certainly had his procedures revised. I'm going to try and find a current pic of him without filler to show what I mean. I'm thinking of a recent interview where his scalp looked like elbow skin.

Failures occur from both procedures, I think there is a common misconception that FUT is some how "fail-proof" in fact, some popular surgeons led the community to believe in this dogamatic view, which of course is a load of garbage. The skill, experience, and talent varies widely from surgeon to surgeon, as do their results. Now, I will contend that there is a real problem with 'black market' FUE performed by untrained technicians with no experience, however, high-quality surgeons such as Dr. Shapiro, Konior, Gabel, and Hasson and Wong have all admitted that FUE in their hands is just as good as FUT. 

So the question isn't about the surgical technique itself, it's about the person executing the technique. In the wrong hands, FUT and FUE can cause permanent damage to both the donor and recipient zones. There is no doubt that biases exist, and they exist on both sides, as previously mentioned there was a popular surgeon on here who vehemently attacked FUE and was very dogmatic in his approach. I think surgeons who perform both FUE and FUT on a consistent basis are a lot less bias and are willing to dive in to the advantages and disadvantages with both. Now, there are cases where FUT may be out of the question, and vice versa, but I think the vast majority of patients benefit from having both procedures, and certainly this maximizes their donor supply better than just one or the other. 

Lastly, when listening to these dogamatic statements made by certain surgeons on a crusade to dispel an entire surgical technique altogether, I'm reminded of a quote from Dr. Konior, who happens to perform both procedures with excellent results and yield.

Quote

 Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. 

 

[bismarck]

4 hours ago, Melvin-Moderator said:

Failures occur from both procedures, I think there is a common misconception that FUT is some how "fail-proof" in fact, some popular surgeons led the community to believe in this dogamatic view, which of course is a load of garbage. The skill, experience, and talent varies widely from surgeon to surgeon, as do their results. Now, I will contend that there is a real problem with 'black market' FUE performed by untrained technicians with no experience, however, high-quality surgeons such as Dr. Shapiro, Konior, Gabel, and Hasson and Wong have all admitted that FUE in their hands is just as good as FUT. 

So the question isn't about the surgical technique itself, it's about the person executing the technique. In the wrong hands, FUT and FUE can cause permanent damage to both the donor and recipient zones. There is no doubt that biases exist, and they exist on both sides, as previously mentioned there was a popular surgeon on here who vehemently attacked FUE and was very dogmatic in his approach. I think surgeons who perform both FUE and FUT on a consistent basis are a lot less bias and are willing to dive in to the advantages and disadvantages with both. Now, there are cases where FUT may be out of the question, and vice versa, but I think the vast majority of patients benefit from having both procedures, and certainly this maximizes their donor supply better than just one or the other. 

Lastly, when listening to these dogamatic statements made by certain surgeons on a crusade to dispel an entire surgical technique altogether, I'm reminded of a quote from Dr. Konior, who happens to perform both procedures with excellent results and yield.

 

I have had extensive conversations with three of the names you have mentioned, and across the board they indicated to me exact opposite of what you stated: strip is unequivocally superior for yield. Not for me in particular, but in general. So I'm not sure where you're coming from with that statement. Perhaps they changed what they said to you because your stance on FUE is so strong and they knew your surgical history, but I was very careful to come in neutral when I spoke with them. Or perhaps their opinions changed over time--my conversations were recent. One of us has fake news on this one.

Blake Bloxham and Feller certainly don't agree with you. Feller has had his problems, but I don't think Blake is coming in trying to sell one procedure over the other for personal gain. I fundamentally agree with his opinion that FUT is better for yield and repeat procedures, FUE is better for not having a scar. I don't think they will be equal for quite some time, though we will not likely know this for sure for at least a couple decades.

But I really don't think it's even debatable at this point.

Edited April 14, 2020 by bismarck

[Melvin- Admin]

12 hours ago, bismarck said:

I have had extensive conversations with three of the names you have mentioned, and across the board they indicated to me exact opposite of what you stated: strip is unequivocally superior for yield. Not for me in particular, but in general. So I'm not sure where you're coming from with that statement. Perhaps they changed what they said to you because your stance on FUE is so strong and they knew your surgical history, but I was very careful to come in neutral when I spoke with them. Or perhaps their opinions changed over time--my conversations were recent. One of us has fake news on this one.

Blake Bloxham and Feller certainly don't agree with you. Feller has had his problems, but I don't think Blake is coming in trying to sell one procedure over the other for personal gain. I fundamentally agree with his opinion that FUT is better for yield and repeat procedures, FUE is better for not having a scar. I don't think they will be equal for quite some time, though we will not likely know this for sure for at least a couple decades.

But I really don't think it's even debatable at this point.

I agree the only reason to go FUE is for the scarring. I’m objective and neutral in fact, you’ll see that I recommend FUT to most. 

I believe you’re confusing my stance on FUE. I believe it is a viable treatment, but by no means am I saying it’s superior. I do however, feel that is on par for top clinics, maybe not as good in terms of growth, but very close.

If you ask even clinics that are known as FUT clinics they will tell you they perform FUE 50% of the time, when I spoke with Dr. Muresanu of Hattingen, he told me his practice was 50/50. Now, would an ethical doctor really be performing a technique that is vastly inferior and provides no cosmetic benefit? I doubt it. 

So I agree with some points, but be careful falling for one clinics description of how viable FUE is, as they can only tell you how it goes for their particular clinic, they can’t speak for anyone else. Good discussion. 

[gillenator]

On 4/10/2020 at 4:13 PM, bismarck said:

He certainly had his procedures revised. I'm going to try and find a current pic of him without filler to show what I mean. I'm thinking of a recent interview where his scalp looked like elbow skin.

Today I saw a news clip of Biden in good light and either he was not using any cosmetics in his frontal zone or his last transplants have thinned out...he had more grafts articulating a new hairline but seems to have receded in the past couple of years.

[gillenator]

Either way,  we have to keep in mind that we are only going to see examples of a clinic's best work whether FUHT or FUE.

In many cases it really comes down to the skill of the surgeon because either method can be argued when comparing the best work done as well as substandard work.

[bismarck]

17 hours ago, Melvin-Moderator said:

If you ask even clinics that are known as FUT clinics they will tell you they perform FUE 50% of the time, when I spoke with Dr. Muresanu of Hattingen, he told me his practice was 50/50. Now, would an ethical doctor really be performing a technique that is vastly inferior and provides no cosmetic benefit? I doubt it. 

Well, it provides an obvious cosmetic benefit on the back of your head.

12 hours ago, gillenator said:

Either way,  we have to keep in mind that we are only going to see examples of a clinic's best work whether FUHT or FUE.

In many cases it really comes down to the skill of the surgeon because either method can be argued when comparing the best work done as well as substandard work.

Very true. Also, even if we restrict our searches to patient submitted cases, our minds tend to focus on the extreme positive and extreme negative results unless we are very careful because those are the most interesting.

[Melvin- Admin]

5 hours ago, bismarck said:

Well, it provides an obvious cosmetic benefit on the back of your head. 

So FUE has no cosmetic benefit to the recipient?