Why are N. American surgeons results so different than well known Spanish surgeons?

[Baldingsoomtm]

Hey guys, long time lurker, first time poster. I hope this post does not come off rude or ignorant. If so, please educate me.

 

I’ve been researching HT for the past four years. Early on in my research I came across a certain surgeon in Spain who’s work is seemingly impeccable. Later in my research I learned of the pitfalls and risks of hair transplants, one of them being to not always trust the results you see clinics post as they typically only post their optimal candidates and results. So I dug a little deeper, joined some Spanish HT forums to see unbiased, direct from the patient experiences. And still, this particular Docs work seems to be miles ahead of anyone in North America, I mean it’s like not even close. And again looking at the Spanish forums it’s consistent.

 

and look don’t get me wrong, there are some great results from the top guys in N. America. It just seems significantly less consistent compared to this guy. Even guys that seemingly have ideal donors, stable loss, same type of hair caliber as the patients posted by this Spanish doc rarely have the same quality results. 
 

im curious about this because I am Italian/Spanish dissent myself. I’m NW 2 in the temples and diffuse crown thinning. My genetics will likely put me at NW4 by 40-45(I’m 32 now). I’ve met with two top surgeons in the US and they both have said similar things about my case. I have excellent donor and will likely have many many grafts available in the future. But both also said they would rather start with the hairline and see how the crown progresses before moving to that area, which I agree with and makes sense. I’m still probably about one to two years out before I want to pull the trigger on anything, so I’m just shopping around. That being said money really is no object to me for this type of elective surgery so I want the best. Only problem is the surgeon I really want to meet with has suspended consultations due to back logs from COVID. I’m contemplating wiring an amount of money they wouldn’t be able to ignore if I could skip that line in the future haha. 
 

...but anyway, I’ve got some time to still research and think about it. So what’s the deal? Does this guy really just have a leg up on everyone else? I’m not sure I buy the “well he only cherry picks ideal candidates” entirely although I do know there is some truth to it. What else am I missing?

[deeznuts]

Which doctors are we comparing?

Is this basically just Couto/Lorenzo/De Freitas vs H&W/Konior? 

[Baldingsoomtm]

Thanks for the reply!

Yeah like I said, totally makes sense to do hairline first. I’m kind of just thinking if I end up holding off on a procedure long enough then I’m sure I’ll want to do crown/hairline together but obviously only if that’s realistic. I really want to do the hairline soon but I also would like to just stick with one surgeon for both sessions. I was quoted a similar amount of grafts by the two docs I’ve already met with(800-1000 in the hairline). So I’m assuming with progressive hair loss in the crown I may need around 2,500 later on. What a Couto seems to be able to do with 2,000 grafts compared to others is very impressive.

 

[Curious25]

42 minutes ago, deeznuts said:

Which doctors are we comparing?

Is this basically just Couto/Lorenzo/De Freitas vs H&W/Konior? 

If it was this match up I would favour the North American doctors over those 3 names mentioned, merely based on having seen more patient posted threads from H&W and Konior - however I haven’t and don’t read non English speaking forums, so that’s not to say there aren’t the equivalent volumes of patient posted threads from the aforementioned Spanish trio. 
 

Qui Bono summarised it pretty well in terms of legislative differences culturally. 
 

Hair calibre plays a huge role, and native Mediterranean patients do tend to have favourable characteristics. 
 

Europe is also very pro FUE - there aren’t many clinics at all that primarily opt for FUT these days over this neck of the woods, which could also help us identify a potential joining of the dots to help answer your question, and it may come down to doctors attitudes; 

Traditionally, hair transplant doctors were focused on playing it conservative with looking to restore slight coverage on top, and not creating aggressive hair lines, or using huge amounts of grafts. This was also during the era of when FUT ruled. 
 

As far as I’m aware, FUT still plays a pretty dominant role across North America, therefore one could potentially assume that the ingrained culture of being more conservative may also still apply across many surgeons and clinics.
 

Without sounding like I’m saying these clinics are stuck in the stone ages, what I’m hypothesising is that European clinics are perhaps more daring, and ambitious with their strategies and clinical protocols, holding a more modern outlook on what is feasible with hair restoration in 2021. 

Edited May 20, 2021 by Curious25

[Melvin- Admin]

Are you talking about Dr. Cuoto? There are several high quality doctors. I don’t think there is one particular doctor that has better work than anyone else in the world. I’d say it’s more of a league. There’s the champions league quality and europa league quality. 

[Baldingsoomtm]

37 minutes ago, Curious25 said:

 

Without sounding like I’m saying these clinics are stuck in the stone ages, what I’m hypothesising is that European clinics are perhaps more daring, and ambitious with their strategies and clinical protocols, holding a more modern outlook on what is feasible with hair restoration in 2021. 

I share the same sentiment and I was thinking of a way to express this without sounding like I don’t respect the experience and expertise the NA surgeons have. 
 
I will go ahead and say it is Couto whom I was mainly referencing. I can read and write Spanish so I have spent some time on Spanish forums doing more research in regards to him. Although one of the surgeons I’ve already met with has been mentioned, I don’t want to mention them myself as my experience with the consultation was excellent and very insightful.

Edit: If there are other surgeons in NA that have particularly good results with darker, Spanish type hair, I would be curious to hear about them in case there have been some I’ve over looked.

 

Edited May 20, 2021 by Baldingsoomtm

[Future Hair Doc]

Mediterranean hair is much easier to work with and get great results. I would say the same applies for Desi and Middle Eastern hair. There is MUCH greater diversity of patients in the US than Spain and Portugal. 

Edited May 20, 2021 by Dr. Suhail Khokhar

[Gasthoerer]

I am not an expert for US clinics outside of the top notch, but I see some great results from clinics all over the world.

There is no magic super doc who is better than all the others. There are just some with better marketing than the peers. 

Just as @Melvin-Moderator says: There is the Champions League and there is the field ... and there is the hair mills. 

[RandoBrando517]

44 minutes ago, Gasthoerer said:

I am not an expert for US clinics outside of the top notch, but I see some great results from clinics all over the world.

There is no magic super doc who is better than all the others. There are just some with better marketing than the peers. 

Just as @Melvin-Moderator says: There is the Champions League and there is the field ... and there is the hair mills. 

Who do you think are the best in Europe?

[Gasthoerer]

Actually, I do not believe there is THE best, only the best for your case.

Some great clinics are IMO (and I am sure I missed some) without any particular order:

- Heitmann (for small Hairlines cases)

- Hattingen (for Mega-FUT Sessions)

- Feriduni (for larger FUE cases and consultation in general, which makes him great for non-standard cases excluding BHT )

- Ferreira (great bang for the buck)

- Mwamba (for BHT and any repairs involving BHT)

- Couto, Lorenzo and all the other spanish clincis (for diffuse thinners due to implanter pen -> Some would consider them the best in the world

- Lupanzula (IMO fairly priced and under-appreciated)

- Bisanga 

... There are many more

- Some would also mention Dr. Zarev for mega session FUE (but I need to see more results 

 

 

[Melvin- Admin]

34 minutes ago, Gasthoerer said:

Actually, I do not believe there is THE best, only the best for your case.

Some great clinics are IMO (and I am sure I missed some) without any particular order:

- Heitmann (for small Hairlines cases)

- Hattingen (for Mega-FUT Sessions)

- Feriduni (for larger FUE cases and consultation in general, which makes him great for non-standard cases excluding BHT )

- Ferreira (great bang for the buck)

- Mwamba (for BHT and any repairs involving BHT)

- Couto, Lorenzo and all the other spanish clincis (for diffuse thinners due to implanter pen -> Some would consider them the best in the world

- Lupanzula (IMO fairly priced and under-appreciated)

- Bisanga 

... There are many more

- Some would also mention Dr. Zarev for mega session FUE (but I need to see more results 

 

 

This is spot on, there are good doctors for different situations as well. Few would argue that Dr. Wong isn’t the best for crown HT’s. I think guys see some impressive results and think right, this doctor has the magic recipe.

Keep in mind, the results you see are a fraction as well. As many results will never be shown because there’s no consent.

[gillenator]

There are literally hundreds and hundreds of procedures (good and bad) that we never see because of non consent.

What we do know is that there are plenty of good skilled surgeons to choose from and it comes down to a personal choice as to who the patient feels will give them the best result based on the merits of each surgeon chosen.

[Otar Norwood]

On 5/20/2021 at 9:32 AM, Curious25 said:

If it was this match up I would favour the North American doctors over those 3 names mentioned, merely based on having seen more patient posted threads from H&W and Konior - however I haven’t and don’t read non English speaking forums, so that’s not to say there aren’t the equivalent volumes of patient posted threads from the aforementioned Spanish trio. 
 

Qui Bono summarised it pretty well in terms of legislative differences culturally. 
 

Hair calibre plays a huge role, and native Mediterranean patients do tend to have favourable characteristics. 
 

Europe is also very pro FUE - there aren’t many clinics at all that primarily opt for FUT these days over this neck of the woods, which could also help us identify a potential joining of the dots to help answer your question, and it may come down to doctors attitudes; 

Traditionally, hair transplant doctors were focused on playing it conservative with looking to restore slight coverage on top, and not creating aggressive hair lines, or using huge amounts of grafts. This was also during the era of when FUT ruled. 
 

As far as I’m aware, FUT still plays a pretty dominant role across North America, therefore one could potentially assume that the ingrained culture of being more conservative may also still apply across many surgeons and clinics.
 

Without sounding like I’m saying these clinics are stuck in the stone ages, what I’m hypothesising is that European clinics are perhaps more daring, and ambitious with their strategies and clinical protocols, holding a more modern outlook on what is feasible with hair restoration in 2021. 

 

On 5/20/2021 at 7:42 AM, Baldingsoomtm said:

Hey guys, long time lurker, first time poster. I hope this post does not come off rude or ignorant. If so, please educate me.

 

I’ve been researching HT for the past four years. Early on in my research I came across a certain surgeon in Spain who’s work is seemingly impeccable. Later in my research I learned of the pitfalls and risks of hair transplants, one of them being to not always trust the results you see clinics post as they typically only post their optimal candidates and results. So I dug a little deeper, joined some Spanish HT forums to see unbiased, direct from the patient experiences. And still, this particular Docs work seems to be miles ahead of anyone in North America, I mean it’s like not even close. And again looking at the Spanish forums it’s consistent.

 

and look don’t get me wrong, there are some great results from the top guys in N. America. It just seems significantly less consistent compared to this guy. Even guys that seemingly have ideal donors, stable loss, same type of hair caliber as the patients posted by this Spanish doc rarely have the same quality results. 
 

im curious about this because I am Italian/Spanish dissent myself. I’m NW 2 in the temples and diffuse crown thinning. My genetics will likely put me at NW4 by 40-45(I’m 32 now). I’ve met with two top surgeons in the US and they both have said similar things about my case. I have excellent donor and will likely have many many grafts available in the future. But both also said they would rather start with the hairline and see how the crown progresses before moving to that area, which I agree with and makes sense. I’m still probably about one to two years out before I want to pull the trigger on anything, so I’m just shopping around. That being said money really is no object to me for this type of elective surgery so I want the best. Only problem is the surgeon I really want to meet with has suspended consultations due to back logs from COVID. I’m contemplating wiring an amount of money they wouldn’t be able to ignore if I could skip that line in the future haha. 
 

...but anyway, I’ve got some time to still research and think about it. So what’s the deal? Does this guy really just have a leg up on everyone else? I’m not sure I buy the “well he only cherry picks ideal candidates” entirely although I do know there is some truth to it. What else am I missing?

It takes a village to do a hair transplant properly, particularly FUE -- no matter how good one guy is, if his team is not legally allowed to help or not extremely good, the patient will suffer. Spain has really mastered the art of finding good help.

 

Edited May 22, 2021 by Otar Norwood

[doogg]

On 5/21/2021 at 12:46 AM, Melvin-Moderator said:

Are you talking about Dr. Cuoto? There are several high quality doctors. I don’t think there is one particular doctor that has better work than anyone else in the world. I’d say it’s more of a league. There’s the champions league quality and europa league quality. 

Hi @Melvin-Moderator, out of curiosity who would you say are in the champion league quality and who are in the europa league quality?
 

thank you!