Instagram Live Q&A with Hasson and Wong

[Melvin- Admin]

Dear community members and forum visitors, 

I will joining be @H & W Doug on July 16th this is a perfect opportunity to get your questions in, please ask any questions you want me to ask him here. Remember, H&W was one of the pioneers of the lateral slit technique, for years they were considered FUT/strip clinic. However, in recent years, they have incorporated FUE into their practice, and now they are truly one of the best FUE clinics in the world. 

Since they are a clinic that consistently puts out great results via strip and FUE, it would be a good time to ask any questions regarding the differences in yield etc. I look forward to your guys questions, we're looking to do more of these, so be on the look out.

[Melvin- Admin]

Bump 

guys good chance to get questions into the doctors, Doug will be getting answers directly from them.

[FuriousGeorge]

Just a heads up - you say March 16th in the post - may want to update as I initially thought this was an old post. 😊

Will send questions in a bit today. 

[Melvin- Admin]

6 minutes ago, FuriousGeorge said:

Just a heads up - you say March 16th in the post - may want to update as I initially thought this was an old post. 😊

Will send questions in a bit today. 

My mistake, I have the quarantine on my mind lol. 

[yesplease]

11 hours ago, Melvin-Moderator said:

Bump 

guys good chance to get questions into the doctors, Doug will be getting answers directly from them.

Do they subscribe to the school of thought that starting with FUT for your first procedure, then “stripping out”, then changing to FUE as needed significantly optimizes one’s lifetime supply of grafts? If so, by what % (on average) does this approach increase lifetime supply vs someone who starts with and only uses FUE? 

[Melvin- Admin]

20 minutes ago, yesplease said:

Do they subscribe to the school of thought that starting with FUT for your first procedure, then “stripping out”, then changing to FUE as needed significantly optimizes one’s lifetime supply of grafts? If so, by what % (on average) does this approach increase lifetime supply vs someone who starts with and only uses FUE? 

Great question, we need more of these.

[Mycroft]

One thing I've always been curious about is how the clinic determines which surgeon a patient is assigned to. I do notice that most of the results we see are Dr. Hasson's, so I wonder if Dr. Wong makes a point of only taking on specific types of cases these days.

H&W shares a number of larger "mega" session results for severe cases and the general philosophy seems to be to do as much as you can in one pass. What percentage of past patients do you see coming back for additional work, whether it's just to add more density or to address further progression of their hair loss?

[Melvin- Admin]

5 hours ago, Mycroft said:

One thing I've always been curious about is how the clinic determines which surgeon a patient is assigned to. I do notice that most of the results we see are Dr. Hasson's, so I wonder if Dr. Wong makes a point of only taking on specific types of cases these days.

H&W shares a number of larger "mega" session results for severe cases and the general philosophy seems to be to do as much as you can in one pass. What percentage of past patients do you see coming back for additional work, whether it's just to add more density or to address further progression of their hair loss?

Great question, I’m curious as well.

[Melvin- Admin]

Btw for you guys who don’t follow us on Instagram our handle is @thehairtransplantnetwork 

[FuriousGeorge]

How many transplants do the doctors do per day?

How long have your techs been with you and what are their strengths? What is the tech involvement for each procedure (extracting, packing, etc)? Can you share why?

It seems you are able to consistently perform larger and denser sessions than most other clinics. Can you provide insight into WHY that is the case? (What is your main differentiator?) 

What current emerging trends you are seeing and how are you thinking to implement in your practice?

 

 

[pre-screened]

20 hours ago, yesplease said:

Do they subscribe to the school of thought that starting with FUT for your first procedure, then “stripping out”, then changing to FUE as needed significantly optimizes one’s lifetime supply of grafts? If so, by what % (on average) does this approach increase lifetime supply vs someone who starts with and only uses FUE? 

+1 on above

H&W, to my knowledge, prescribes a topical finasteride......what is the solution mix they think is most effective........also without clinical data do they think it shows the same efficacy as oral?

Opinion on PRP?

Finally any opinions on Exosomes at this point?

[GE90]

Also want to know their opinion on topical fin:

- do they prescribe both topical and oral these days 

- which brand/supplier of topical fin do they use

- efficacy oral vs topical 

[Melvin- Admin]

Good questions guys, 

Don’t hold back, how about the whole DHI, DHT phenomenon. Some believe that DHI is somehow the best transplanting technique, personally I think it’s nothing more than a marketing gimmick. That’s something worth asking.

[asterix0]

Thank you Melvin for giving us this opportunity to ask questions.Mine would be:

How many more lifetime grafts are available from the FUT procedure vs FUE?

Intuitively, one would think a slim line from FUT would allow all the rest of the donor area to be "pristine", and thus available for more grafts down the road. However, due to considerations such as decreased scalp laxity and potential scar widening, it is understandable why patients are looking more and more to FUE. But, would an FUE only restoration approach significantly limit the number of available grafts to use for future procedures? 

"Significantly" is a pretty imprecise term so I apologize, but how big is the margin? 5%? 10%?

Thanks a lot 🙂

Edited July 12, 2020 by asterix0

[Melvin- Admin]

17 hours ago, asterix0 said:

Thank you Melvin for giving us this opportunity to ask questions.Mine would be:

How many more lifetime grafts are available from the FUT procedure vs FUE?

Intuitively, one would think a slim line from FUT would allow all the rest of the donor area to be "pristine", and thus available for more grafts down the road. However, due to considerations such as decreased scalp laxity and potential scar widening, it is understandable why patients are looking more and more to FUE. But, would an FUE only restoration approach significantly limit the number of available grafts to use for future procedures? 

"Significantly" is a pretty imprecise term so I apologize, but how big is the margin? 5%? 10%?

Thanks a lot 🙂

My only issue with that question is why choose one? Obviously the best route would be FUT first, and then FUE the rest. You will get way more grafts than choosing one. Remember FUT and FUE are not mutually exclusive. 

[asterix0]

2 hours ago, Melvin-Moderator said:

My only issue with that question is why choose one? Obviously the best route would be FUT first, and then FUE the rest. You will get way more grafts than choosing one. Remember FUT and FUE are not mutually exclusive. 

Why would you get more grafts with FUT first? That is something I posted in another thread, but could not find a study or conclusion. Many surgeons sort of state this as a matter of fact statement.

In fact, some surgeons such as Dr.C advocate you can get more lifetime grafts via FUE. He doesn't have statistics that back this up, but he asserts it.

I guess what I would want to know is, how many grafts would I be giving up for future use if I exclusively went for FUE procedures vs combining FUT + FUE?

[asterix0]

To maybe phrase my question more precisely, let's say hypothetically a surgeon was able to optimally extract 2000 FUE grafts, minimizing the amount of surrounding damage as much as possible to the donor. 

If we assume this, would the donor damage still be greater than a 2000 graft FUT procedure, and still leave you with less available lifetime grafts?

Basically, is the FUE procedure by its very nature inherently worse in terms of lifetime donor management, or has surgeon instrumentation/technique/technology still not advanced enough to match FUT in this regard?

Why is this question important, well suppose I know that I am headed to a high Norwood, but am also very reluctant to risk getting a bad linear scar from FUT. So I am now weighing the loss of future available donor via FUE vs the chances of a keloid, widened, linear scar that prevents me from wearing my hair short in the back.

If FUE donor management, if not now but in the future, could mitigate the gap with FUT, then this would greatly help patients like me. Even if that meant getting 2 -> 2000 graft FUE procedures, or 3 -> 1300 graft procedures, vs 1 FUT 4000 graft procedure, thus costing me much more money and time. But the absence of the linear scar and the relatively similar yields + future donor capacity would be worth that time and money (to me).

Edited July 13, 2020 by asterix0

[Melvin- Admin]

My point is that you will always have more lifetime grafts combining both. This is an indisputable fact. Why? Simple, you’re removing every possible graft in the donor area without risking a moth eaten appearance. There’s no way you’d be able to get the same number of grafts with FUT alone or with FUE alone. 

Now, whether you should start FUT first or if it’s okay to FUT down the line is a different question entirely, but I think asking about lifetime grafts is a moot point if you know that combining both methods= equals more lifetime grafts.

[asterix0]

1 hour ago, Melvin-Moderator said:

My point is that you will always have more lifetime grafts combining both. This is an indisputable fact. Why? Simple, you’re removing every possible graft in the donor area without risking a moth eaten appearance. There’s no way you’d be able to get the same number of grafts with FUT alone or with FUE alone. 

Now, whether you should start FUT first or if it’s okay to FUT down the line is a different question entirely, but I think asking about lifetime grafts is a moot point if you know that combining both methods= equals more lifetime grafts.

Thank you for your reply Melvin, it isn't obvious to me why so that's why I asked. Some sort of metrics as to how much more donor you can potentially have by combining them would be nice, if they exist at all.

Could the Hasson and Wong team perhaps provide such information, if they have records or insight into that? Of course without breaching any patient confidentiality rules. 

Edited July 13, 2020 by asterix0

[Melvin- Admin]

19 minutes ago, asterix0 said:

Thank you for your reply Melvin, it isn't obvious to me why so that's why I asked. Some sort of metrics as to how much more donor you can potentially have by combining them would be nice, if they exist at all.

Could the Hasson and Wong team perhaps provide such information, if they have records or insight into that? Of course without breaching any patient confidentiality rules. 

How many grafts extra do you get combining FUT and FUE, as opposed to choosing only one method? Now thats a valid question. Remember both techniques are not mutually exclusive, the biggest mistake that people make is make it a FUT vs FUE situation. 

[asterix0]

21 minutes ago, Melvin-Moderator said:

How many grafts extra do you get combining FUT and FUE, as opposed to choosing only one method? Now thats a valid question. Remember both techniques are not mutually exclusive, the biggest mistake that people make is make it a FUT vs FUE situation. 

Yes, the bolded 🙂

[Melvin- Admin]

In case you guys don’t follow us our handle is @thehairtransplantnetwork

[Sam818]

thanks Melvin I got a couple 

1. I’ve noticed FUE surgeries with clinics that are very detail oriented tend to take longer which means grafts are out of the body longer. How long are you comfortable with grafts being out of body before implanting? 

2. The increase of social media marketing platforms such as Instagram has also brought on the increase of unethical and unskilled doctors performing this surgery around the world. Are you seeing an upward trend in patients seeking repair procedures?

[Melvin- Admin]

Excellent questions.

[FuriousGeorge]

One more from me:

H&W consistently shows amazing work. I typically see larger megasession results in your portfolio than other also highly-skilled, reputable doctors.

Can you share your philosophy for this and the long term implications? For example, many doctors quote/perform more conservative procedures with the idea of "Don't waste what you don't need" and that patients will come back for an additional procedure to fill in the gaps with an additional 1-2K grafts - whereas it appears H&W can do it in one major procedure (assuming the patient is a good candidate).

Some professionals in the field would argue densely packing a mega-session is wasting grafts and can jeopardize what patients can use in the future - can you help us understand the differences in philosophy and the benefits for the patient both in the short term and long term?