Instagram live with Dr. Wong and Remy Hair Technician

[Melvin- Admin]

Today, I will have the pleasure of speaking to Dr. Wong and @Remy Herda one of their technicians that recently got an HT. What questions do you guys have for Dr. Wong or Remy? 

[Curious25]

Nice , will try and tune in. 
 

Can you ask about ascertaining a patients ‘safe donor area’. 
 

At what age are they confident they can identify the probability of someone turning no more than a NW5 as opposed to NW6, and therefore extract higher from the traditional NW6/7 safe zones we used to be accustomed to seeing. Also - what other criterias do they consider that help them to identify the area they are confident in extracting from. 
 

Thanks mate

[Melvin- Admin]

Great question and topic.

[Future Hair Doc]

Does he prefer sutures of staples for closure? And why? 

[kramer79]

His take on the whole maximizing/managing donor supply lifetime (FUT/FUE)

[Melvin- Admin]

5 minutes ago, kramer79 said:

His take on the whole maximizing/managing donor supply lifetime (FUT/FUE)

Do you mean using FUE first, as opposed to FUT first?

[kramer79]

3 minutes ago, Melvin-Moderator said:

Do you mean using FUE first, as opposed to FUT first?

In case SLA does not make it in time, i know he has previously posted the following:

 

In my research on this very topic, below I have documented views found through research and/or consulting with several well known and regarded FUE only surgeons, many who have left performing FUT (claiming that it wasn't entirely market driven).

As you look at the arguments given by these FUE only surgeons below, do you think there is any validity to any of them which would in actuality lead to their being less of a difference in lifetime grafts being able to harvest in FUE alone (over several procedures) vs combining both techniques over several procedures.

 

Thank you!

1. If you do an FUT, you need to leave hair to hide the linear scar, so you wouldn't be able to extract as much with FUE in subsequent procedures

2. FUT alters the direction of hair growth making it more difficult to extract afterwards with FUE

3. When you perform FUT, the skin stretches which causes a downward displacement of the crown expanding the area of baldness, so the extra follicles you might obtain from an FUT strip is negated by the expanded area of baldness in the crown you must now cover

4. You inevitably transect follicle when you cut the FUT strip

5. When FUT is performed, hair in the growth and telogen phase is often not found and/or hard to extract and is discarded or transected, but with FUE, you can select hairs

6. If a follicle is transected while dissecting the strip, it is unusable, but if transected with FUE it can remain in vivo for future use

7. You can always get more GRAFTS with FUT as there is subdivision which takes place when dissecting. For instance one grouping with 4 hairs can be divided into 2 groups of 2

8. FUT transplants can create more donor thinning below the strip scar making those follicle unextractable (or more difficult to extract) by FUE. A top surgeon well respected on this forum sent me photos of this from actual patients

9. Hairs not in proper phase may not survive the dissection

[Melvin- Admin]

1 hour ago, kramer79 said:

In case SLA does not make it in time, i know he has previously posted the following:

 

In my research on this very topic, below I have documented views found through research and/or consulting with several well known and regarded FUE only surgeons, many who have left performing FUT (claiming that it wasn't entirely market driven).

As you look at the arguments given by these FUE only surgeons below, do you think there is any validity to any of them which would in actuality lead to their being less of a difference in lifetime grafts being able to harvest in FUE alone (over several procedures) vs combining both techniques over several procedures.

 

Thank you!

1. If you do an FUT, you need to leave hair to hide the linear scar, so you wouldn't be able to extract as much with FUE in subsequent procedures

2. FUT alters the direction of hair growth making it more difficult to extract afterwards with FUE

3. When you perform FUT, the skin stretches which causes a downward displacement of the crown expanding the area of baldness, so the extra follicles you might obtain from an FUT strip is negated by the expanded area of baldness in the crown you must now cover

4. You inevitably transect follicle when you cut the FUT strip

5. When FUT is performed, hair in the growth and telogen phase is often not found and/or hard to extract and is discarded or transected, but with FUE, you can select hairs

6. If a follicle is transected while dissecting the strip, it is unusable, but if transected with FUE it can remain in vivo for future use

7. You can always get more GRAFTS with FUT as there is subdivision which takes place when dissecting. For instance one grouping with 4 hairs can be divided into 2 groups of 2

8. FUT transplants can create more donor thinning below the strip scar making those follicle unextractable (or more difficult to extract) by FUE. A top surgeon well respected on this forum sent me photos of this from actual patients

9. Hairs not in proper phase may not survive the dissection

That’s a lot to remember haha, I will do my best, but guys please if possible join. The best thing is to have this session interactive.

[kramer79]

44 minutes ago, Melvin-Moderator said:

That’s a lot to remember haha, I will do my best, but guys please if possible join. The best thing is to have this session interactive.

No pressure haha.

What time is it at? how do we join?

[deeznuts]

4 hours ago, Curious25 said:

Nice , will try and tune in. 
 

Can you ask about ascertaining a patients ‘safe donor area’. 
 

At what age are they confident they can identify the probability of someone turning no more than a NW5 as opposed to NW6, and therefore extract higher from the traditional NW6/7 safe zones we used to be accustomed to seeing. Also - what other criterias do they consider that help them to identify the area they are confident in extracting from. 
 

Thanks mate

My question is pretty much this one since I was wondering how/when we can determine someone's final balding pattern. And if you know your final balding pattern, assuming it's not particularly aggressive, if you could take a calculated risk and get off drugs

[Melvin- Admin]

Guys,

Were going live in 40 minutes.

[Melvin- Admin]

22 minutes ago, kramer79 said:

No pressure haha.

What time is it at? how do we join?

It’s at 5pm pacific time. You can join by going on our IG page @thehairtransplantnetwork

[Melvin- Admin]

It was great, you guys get to here some SUPER insightful info on crowns. Definitely watch till the end, we talked about robotic FUE.

https://www.instagram.com/tv/COJn2--HCrt/?igshid=ufqi75ew8yuw

[pre-screened]

Great interview......Sound was a little off during medication discussion - @Melvin-Moderator - did I hear or understand correctly that topical DUTASTERIDE is what Dr.Wong thinks will likely be the gold standard moving forward.....even more so than topical finasteride?

Edited April 27, 2021 by pre-screened

[Melvin- Admin]

10 minutes ago, pre-screened said:

Great interview......Sound was a little off during medication discussion - @Melvin-Moderator - did I hear or understand correctly that topical DUTASTERIDE is what Dr.Wong thinks will likely be the gold standard moving forward.....even more so than topical finasteride?

Yes, it did get a little muffled. But Dr. Wong didn’t want to say too much other than he believes topical fin and dut will become the gold standard, very exciting 

[pre-screened]

19 minutes ago, Melvin-Moderator said:

Yes, it did get a little muffled. But Dr. Wong didn’t want to say too much other than he believes topical fin and dut will become the gold standard, very exciting 

Thanks - I got the impression from him that I guess topical finasteride being off label is all he was comfortable talking about given at least the base compound is FDA approved for hairloss - but spotted a nod of acknowledgment that topical Dustarisde (where systemic absorption & therefore DUT side effects is limited by their compounding solution) would be superior

Edited April 27, 2021 by pre-screened

[deeznuts]

Really interesting to hear one of the top docs in the world endorse topical dutasteride. Not that the other doctors like Dr. Wesley aren't top docs, but hearing Dr. Wong outright saying he believes it's the future intrigues me. Obviously there are a few docs that are selling it, but listening to an endorsement from Dr. Wong really makes me feel a lot more confident about it. Might be time I send Dr. Mwamba some money...

Also, thanks for asking my question. I hope Curious's question was satisfactorily answered for him as well. So it does seem like you can't determine for sure but with an educated guess, it's very very rare that hair loss progresses to a point where donor hair is insufficient. Dr. Wong spends some time talking about the worst case scenario (that you progress towards a NW7 and end up as one of those handful of patients who run out of donor) but I'm kinda curious what the average case scenario is as far as making these educated guesses. I don't believe I have any NW7s in my family - I think my uncle was a NW5 or so at like age 40 but now he shaves his head so I can't even say for sure. Both my grandfathers are dead. One of them had great hair, and the other was bald.

Also, I can't believe I forgot to ask what H & W offers for lunch. I heard it was included in the package... Any chance Remy can answer this for us 😁

 

 

Edited April 27, 2021 by deeznuts

[Curious25]

Thanks for another great interview Melvin. 
 

1 hour ago, deeznuts said:

Really interesting to hear one of the top docs in the world endorse topical dutasteride.

Totally agree. Especially when he has nothing to currently gain from it, as it is not a product they are able to offer. 

[Curious25]

1 hour ago, deeznuts said:

Also, thanks for asking my question. I hope Curious's question was satisfactorily answered for him as well. So it does seem like you can't determine for sure but with an educated guess, it's very very rare that hair loss progresses to a point where donor hair is insufficient. Dr. Wong spends some time talking about the worst case scenario (that you progress towards a NW7 and end up as one of those handful of patients who run out of donor) but I'm kinda curious what the average case scenario is as far as making these educated guesses. I don't believe I have any NW7s in my family - I think my uncle was a NW5 or so at like age 40 but now he shaves his head so I can't even say for sure. Both my grandfathers are dead. One of them had great hair, and the other was bald.

Yea Thankyou for asking my question. One of the reasons I was particularly intrigued, is because I have noticed that Dr Hasson in particular is seemingly quite comfortable to extract outside of the NW6 zone in a lot of his patients under 35, so it was good to hear Dr Wongs take on it. 

It is encouraging to hear that with correct donor management, most patients don’t have to worry about running out of donor, even more so when he was very confident about the achieving good density coverage on most NW6’s. 

A true NW7 is a very aggressive pattern of loss, they literally have a very thin strip of hair between their two temple regions and along the occipital, which is usually also diffusely thinned. You occasionally see these unfortunate gentlemen out and about in public, however I genuinely believe I see more aged 45+ NW1’s than I do true NW7’s. 

[Melvin- Admin]

What intrigued me the most was his thoughts on crown hair restoration. He said before they said the crown was a black hole. But now, he doesn’t feel the same, based on his technique he can get good visible density with 1,500-3,000 grafts. He also confirmed that the reason why grafts yield low in the crown is the blood supply is poor. He has a technique for preserving blood vessels. Overall, I’m super intrigued and want to pay him a visit once the border opens up to here more about this technique. 

[Curious25]

1500 grafts in his hands could be you set for good mate! 

[Melvin- Admin]

My only apprehension is doing strip. I don’t really wanna do strip. But maybe if it was only on one side. 

[Curious25]

33 minutes ago, Melvin-Moderator said:

My only apprehension is doing strip. I don’t really wanna do strip. But maybe if it was only on one side. 

Would it have to be FUT? 

[Melvin- Admin]

38 minutes ago, Curious25 said:

Would it have to be FUT? 

Yea, I’m fairly certain my donor can’t withstand that much with FUE alone, not in one shot. 

[cpfm]

17 hours ago, Melvin-Moderator said:

What intrigued me the most was his thoughts on crown hair restoration. He said before they said the crown was a black hole. But now, he doesn’t feel the same, based on his technique he can get good visible density with 1,500-3,000 grafts. He also confirmed that the reason why grafts yield low in the crown is the blood supply is poor. He has a technique for preserving blood vessels. Overall, I’m super intrigued and want to pay him a visit once the border opens up to here more about this technique. 

Thanks for the interesting Live! Loving the series.

Would love to see a Live with Dr. Mwamba about HT's and about Topicals (FIN, DUT, MIN) since he sells them and hopefully have data to support Dr. Wong claims about topical duta.