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Can I please get advice on which surgery to do?


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3 minutes ago, TorontoMan said:

Lol where do you get info that Bisanga could only extract 4K grafts from?

According to their own website: https://bhrclinic.com/fue-or-fut-first-thats-the-question-2/

FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT.  Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed according to the protocol we use at BHR clinic, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp.

...

[...] grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics. 

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Ditto, extracting 5000 grafts for example via FUE is MUCH more time and labor intensive compared to FUT but Dr. Zarev already showed us it's possible, or no? The guy does 9000 graft sessions in two days, working 10-11 hours each day. 

 

Edited by JohnBob
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For high norwoods majority will recommend going FUT first. The other issue is that for high norwoods if you go higher than 7000 grafts your donor will start to look depleted unless you have an extremely high density. The other issue for high norwoods and extracting too many grafts without looking depleted is having to extract from the unsafe zone. This is a possibility that has to be accepted. Just look at pictures of where extractions are being performed from and you can see how for high norwood these can possibly be from the unsafe zone. Communication with the surgeon has to be paramount to ensure nothing outside of the safe zone will be extracted. So once you reach a certain number of grafts via FUE scalp will be out of the question. For low norwoods FUE only makes complete sense. If you look at the largest graft cases performed you will see that they are almost always FUT. If you ask any surgeon who performs both FUT and FUE they will always advise to go FUT if you require a high number of grafts. 

But with advancements in BHT FUE can come close to FUT but if you start with FUT first you would still end up with more grafts.

Edited by deitel130
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Dr. Feller has a nice article explaining the difficulties of doing mega sessions via FUE that helped me understand better the technical challenges related to it. The full article is here: https://fellermedical.com/hair-transplant-mega-session/

Some of the most interesting parts related to FUE:

 

Quote

Can a mega session be done as both an FUE or an FUT?

Sure, anything “can” be done. The real question is: should a mega session be done as an FUE or an FUT? The answer, is no. The FUT process lends itself to mega sessions; the FUE technique simply does not. In an FUT mega session, a very large number of grafts can be removed without damage, dissected microscopically into perfect grafts, and placed back into incisions all within a number of hours. The “out of body” time is low, the stress for the patient is low, and the grafts are positioned for optimal growth. What’s more, the damage in the donor is minimal and the donor is left in the best shape for future procedures. The FUT procedure only creates 1 linear scar in the donor region. This means there is only one small area of damaged tissue, the rest is untouched and available for future surgeries. And the size of the scar does not differ based upon the number of grafts removed. You can take 5,000 grafts or 500 grafts, you still only have one linear scar with untouched tissue all around it. This means you can do multiple mega sessions as an FUT and transplant sometimes tens of thousands of grafts if necessary.

The same cannot be said for an FUE mega session. If done properly, the time required for a doctor to safely extract thousands of grafts via FUE is massive. So this leaves a clinic claiming to perform FUE mega sessions with only a few options: 1) keep the patient at the clinic for 14 or 16 hours extracting grafts; 2) split the graft extraction phase up into several days; 3) look for ways to speed up the graft extraction process by doing things like using automated or robotic devices or allowing multiple non-doctor technicians to extract grafts at the same time. All of these methods result in the same thing: lower graft quality, more out of body time for the grafts (which leads to drying out and graft death), and poorer results with massive donor damage. Think of the hair follicle as a fragile organ — which it actually is. Now imagine that you must remove that organ using a small, circular tool and forceps (tweezers). In order to remove that organ with minimal damage, you would need to carefully cut around it without cutting through it or removing too much of its surrounding tissue, and you would then need to gently pull it from the connective structures without causing too much ripping or tearing damage. This describes a gentle, responsible FUE process. However, this also describes a process that takes a lot of time, focus, and attention to detail. And it is not possible to put this much time and effort into graft extraction if you must remove 2,500 grafts. So clinics must resort to tactics that cause more damage and less growth. What’s more, an FUE mega session wreaks havoc on the donor region. Unlike the FUT procedure, which leaves only one small line of scarred, damaged tissue, the FUE procedure causes massive, widespread scarring in the donor region. This scarring changes the entire dynamic of the skin and makes future procedures less certain and less predictable.

So with higher graft damage, lower growth, increased donor damage, and uncertainty of future procedures, single surgery mega sessions should only be done as FUT.

And more about mega sessions 

Quote

What does it take for a clinic to perform mega sessions?

Simply put, a clinic needs two things to perform mega sessions safely and effectively: a very large, highly trained staff and experience doing large cases. It is not possible for one doctor to perform a mega session alone. It would take days for a single doctor to remove 2,500 grafts from the scalp, treat them under microscopes, create 2,500 incisions for the grafts, and place the 2,500 grafts back in to the balding areas. Even if the doctor and patient had the stamina, the grafts would never survive and grow! In order to make these mega sessions work, the doctor must operate with an army of highly trained “super technicians.” These “super technicians” are medical/surgical assistants who have been trained to properly handle, dissect, and place grafts. They must be trained by the doctor performing the procedure, and they must know how to work with the doctor and with each other. Think of a mega session as a highly choreographed performance or a well-oiled machine. Each small part must work perfectly in-and-of-itself and with the other parts. If it doesn’t, the procedure doesn’t work. And each technician is a crucial part of this performance. What’s more, a mega session calls for a lot of them. In order to produce the highest quality grafts and ensure the safest and most efficient placement, a clinic should have 1 technician for every 450 grafts. This means that for a 2,500 graft mega session, you need at least 4-5 technicians. For a 4,000 graft case, you’d want around 7-9 technicians. If a clinic is recommending a mega session and they do not have the staff, walk away.

Another crucial aspect is the clinic’s experience with mega sessions. A clinic simply cannot go from performing 500 or 800 graft cases with 1 or 2 technicians to mega sessions surgeries overnight. It takes a lot of time, training, and man power to do this. The more of these procedures the clinic has done and the more experience the entire team has with mega sessions, the better your grafts will be handled, the less time they will sit out, and the better the results will be. Any patient considering a mega session should ask to see dozens of examples of the clinic’s mega session results. Again, if they can’t show you these and ensure you that they still have a team capable of handling these cases, walk away.

What he says makes total sense. But if he is saying to totally true, then doing what Dr. Zarev is doing would be impossible - unless he really had a breakthrough in terms of technology. 

Edited by JohnBob
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10 hours ago, Gasthoerer said:

You should present you case in here in proper manner (info, pics etc). Otherwise one cannot give great advice.

Anyhow: You loss is severe and the clinics you chose are not really high end in my opinion. Do not be cheap with your own head. 

Where do you recommend? I love in central europe, so turkey is close 

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