Methods used by different surgeons?

[Euphoria]

Before I was banned, I did some pretty extensive research on ncbi/ihrs(?) and learned somethings that I wanted to share.

Graft survival which decides how good of a HT you will have absolutely depends on how long the graft stays outside the body. Graft survival is actually not that bad when they put it in the cold solution they use and enhanced with prp/different solution types. The survival still drops as the hours go on.

But what absolutely kills grafts in a matter of seconds is the time spent on surgeon’s gloves due to desiccation/drying. I forgot the figures now but it was something like with 5? or 10 minutes the grafts die off real quick. Even at 2 minutes the figures were bad. 

This made me interested in seeing how the different surgeons perform their surgeries.

Dr Turan/ fuecapilar(?) posted videos on his YouTube of live surgery and I liked his method, he does a few things right. First he doesn’t put the grafts on his gloves instead they’re in a pen - awesome. I couldn’t see in the video if they load up the implanter pens direct after extraction or grafts are in a solution and for how long and how do the techs load up the grafts since that’s where damage can happen too. But given his results so far (though very few posted here), he must be doing the extractions good as well since the results are good. I don’t think dr gur posted his videos so I didn’t check or maybe I just didn’t think of him.

This is similar to Zarev who also uses an implanter pen. And the time outside body for grafts is very less. Dr Zarev also uses an extraction method that he hides and will not disclose so perhaps his extraction damage rate is very less. Unfortunately, his video is blurred so it’s hard to tell how the pens are loaded but given his awesome results, we can tell he handles the grafts with ❤️
 

So far DHI/Choi implanter pens are clear winners and I wondered if this was the best. But not so fast.

I checked Dr Ozlem Bicer next who was kind enough to post her videos on YouTube and noticed something interesting. The grafts are placed in a solution and she picks up those grafts one by one with a forcep while implanting them without putting them on her gloves. Again, I don’t know how long the time before extraction to implantation but she is highly rated as well and once again, there’s zero time spent on gloves = less time spent in desiccation/drying in forceps. 

Last but not least I came across Eugenix article, they didn’t have a video but they use a method called DHT which is just a fancy name of their technique to appeal to public. I thought it was implanter pen DHI but nope, it’s FUE. What the article by them explained is they make the implantation incisions first then extract the graft and implant it = very little time for graft outside body = no drying/desiccation and their hair growth results are good. Recently their bad results are over-harvesting/bad angles which is where skill of surgeons comes in but the hair grows ie grafts survive.

Of course, the skill of the surgeon is important as well so is extraction which decide how natural the hair look but the procedure that I saw on some hairmills/average doctors was they would put several grafts on the gloves and the time spent implanting them is many minutes. You’re racing against the clock in seconds man, it’s no surprise that the results are so hit and miss with gloves method. They probably damage the grafts during extraction as well, pretty much nothing good going on for the poor hair follicles 😂

It seems the DHI method is the best and removes one more way for grafts to die during the whole process ie drying on gloves even for less good surgeons. Does anyone know what methods the surgeons use that are recommended here? 

PS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956960/

https://pubmed.ncbi.nlm.nih.gov/16369053/

[Euphoria]

I just remembered, I also checked Dr Yaman and it confirmed again what I had seen so far. He uses his custom implanter pen (perhaps for better angles?) but places the grafts on his gloves. And what do you know, there was a result here where the hair growth was not so good ie hair follicles didn’t grow. There’s no doubt he is a good surgeon as he has good results too but even skill will not save you when you’re racing against the clock in a matter of seconds. 

Keep in mind I am not saying just because a surgeon uses gloves method, he will have bad results but that’s just a risk he’s taking. That article mentions grafts dying on gloves in 3-15 minutes, why even subject the grafts to such risk? Personally, after learning this I will go with a surgeon who doesn’t subject the follicles to this risk. Even one hair follicle is precious = that’s 1-4 hairs that you can stick toppik to 😁 and add density. And not minitiarised hairs but prime healthy hair(s), even a thinning scalp looks better than shiny bald one so every follicle is important.

Edited June 2, 2022 by Euphoria

[HappyMan2021]

This is very informative. But at the same time I think it is going to drive prospective HT patients completely crazy if they feel they need to know such granular details as to what specifically a doctor does with an implanter pen, etc. 

Go to a highly rated doctor with a lot of experience and consistent results. 

It really sucks having to put so much faith and trust in a random person you are making such an investment in and likely will never see again, but at the end of the day you really just have to trust the process. 

 

[BaldDude]

If the grafts don’t survive wouldn’t that show pretty quick? 

[Euphoria]

1 hour ago, BaldBobby said:

If the grafts don’t survive wouldn’t that show pretty quick? 

Unfortunately no. It’s not possible to see which ones are damaged until half a year later. Check the bad results posted here and you will notice they are no different than good results in first month. 

[Euphoria]

2 hours ago, HappyMan2021 said:

This is very informative. But at the same time I think it is going to drive prospective HT patients completely crazy if they feel they need to know such granular details as to what specifically a doctor does with an implanter pen, etc. 

Go to a highly rated doctor with a lot of experience and consistent results. 

It really sucks having to put so much faith and trust in a random person you are making such an investment in and likely will never see again, but at the end of the day you really just have to trust the process. 

 

Yeah, people with lower norwoods don’t need to worry so much, they have so much donor zone, even a mediocre surgeon with mediocre survival rates will give good results. Plenty of lower norwoods come out happy from hairmills for this reason. 

I was researching this for myself since I am nw6 and every follicle is important for me 😁

Did some more digging and Dr Pitella also uses a pen (not sure if custom or the dhi Choi pen) and no gloves method. He has some amazing results posted here of high norwoods, also does dense packing. 

H&W which are highly rated here (haven’t seen their results personally) use a really weird ring type thing lol it must be wet for follicle to be happy in though I can’t really tell. 

 

So far the doctors known for great results with higher norwoods all seem to be using pen or handling hair follicles without placing on gloves.

I am going to see HLC, Pekiner, Demirsoy and some more surgeons methods tomorrow. Annoying to browse through tons of videos of patients results to see surgery videos (not always posted unfortunately)

[Rahal Hair Transplant]

Euphoria,

Nice work in taking the time to research the various implantation methods surgeons use.  Forum members, prospective patients and patients typically spend most of their time discussing extraction and harvesting methods which is great but people often forget that implantation is equally as important.

Follicular units are very fragile and the viability of a graft depends on many factors. For instance, the stability of a graft is directly related to the amount of tissue surrounding the hair follicle.  While small punches are covented, preferred and used by the most skilled surgeons, there is less tissue surrounding the follicle and thus, the graft is more fragile.  Whether or not follicles are damaged in anyway is dependent on the following factors:

1. Extraction - there are three forces placed on hair follicles during FUE. This includes traction, torsion and tension.  Thus, surgeons/technicians need to be extremely careful during the extraction process in order to minimize these forces to prevent any damage/transection.  For surgeons using a powered device rather than a manual one, heat also becomes a factor. 

Note: After extraction, Dr. Rahal’s technicians evaluate each individually extracted follicular unit under microscopes to check for transection or any damage.  This is done for every procedure and only those that are not damaged are inserted. The percentage of viable grafts are in the high 90 percentile at our clinic   Not many surgeons or clinics take the time to do this but frankly, I think it’s very important and that all clinics should consider doing this.

2. Time outside of the body - as stated above, follicular units are fragile and the less tissue surrounding the follicle, the less stable they are.  Desiccation/dehydration is a real possibility if the grafts are not kept in an adequate holding solution and remain outside of the body too long. Thus, minimizing time outside of the body is crucial in preventing desiccation which is why some clinics employ a “stick and place“ technique and/or use holding solutions that contain natural additives such as platelet rich plasma (PRP) which will increase the viability of the grafts and allow for them to be outside of the body a little longer.

3. implantation - there are multiple ways to implant follicular units into recipient sites.  Some will carefully insert the grafts using forceps while others, like Dr. Rahal will employ a “no touch“ technique using implanter tools. Implanter tools enable a surgeon/technician to carefully implant the transplanted hair into recipient sites without having to touch them with their hands.

I think it’s important that prospective patients understand the various techniques that surgeons use and why. However, there are multiple ways to obtain the same excellent results and different surgeons/clinics will employ the methods that they feel work best for them.

At the end of the day, the particular nuances and procedures, while important, don’t matter nearly as much as a consistency in producing excellent results.  But, I also believe that knowledge is power. The more you know about these particulars, the more educated and informed a prospective patient will be and a more educated decision they’ll be able to make.

Best wishes,

Rahal Hair Transplant