3000+ w/ Dr. Paul Shapiro on 10/26/06

[reversethecurse]

The Procedure

 

Needed multiple local anesthetic injections as I metabolized the medication quite quickly and it was a lengthy procedure. Also needed a few "nerve block" injections above the eye sockets to achieve lasting numbness. This proved effective.

 

Strip removal was pretty straightforward and uneventful, although my BP was high for a while, so they waited till it came down to do the surgery to prevent excess bleeding. Took another valium around lunch time because i was feeling a bit nauseous (maybe the prednisone, maybe hearing the slits being cut in my head).

 

More anesthetic after lunch, and slight nauseousness returned. Vicodin seemed to releive this and relax me completely. After the afternon vicodin, the remaining evening hours went much smoother with more incisions and placing of grafts.

 

Impressions

 

Dr. and staff made the procedure as comfortable as possible, and after getting through it, i can tell that a future procedure will go much more smoothly as my pre op jitters proved to be unfounded (my BP was high).

 

It was a long day for everyone - could have gone quicker if i didn't need to take several breaks to stretch and to get more anesthetic.

 

Very happy with results, although some recipient sites developed evidence of staff infection the following day. Probably should have worn a brand new hat instead of the same one i was wearing for months prior.

 

Recovery

 

Came to clinic the next day where Dr. identified staff infection and prescribed 10 day course of antibiotics.

 

Returned 4 days after surgery and inspection indicated that the antibiotic was taking care of staff, although still visible.

 

Returned 10 days after for suture removal - went smoothly, gave me another wash and took the "after" shots on my weblog - scabs and any signs of infection are completely gone.

 

Also - have had more than usual swelling and bruising around the eyes due to the nerve block injections above the eye sockets. Not a big deal - just a bit longer recovering and wearing sunglasses in public like a rock star.

 

FU Breakdown

 

FU # Grafts # Hairs

1 448 448

2 1592 3184

3 680 2040

4 133 532

6 207 1242

 

Total: 3060 7446

 

Any feedback would be welcome - my specific question right now is:

 

When can i expect to shed the grafts? I'm not sure if i should shave the remaining so it doesn't looks so dorky, or if i will definitely shed or not. Is there a time after which you can say that the shedding period is over so you can be sure that they're going to stay and grow?

 

Also - I've been on Propecia since the end of September. (& multi-vitamins each day)

 

 

Thanks -

 

scape

[hairbank]

rtc-

 

Welcome to HTN's forum. I enjoyed viewing your blog as I hadn't seen much from Dr. Paul...........the work looks great. Since you had some native hair to blend with I'll bet you'll be pleased with your results.

 

I detected in your post the hint of another pass in the future? If you lose more in the future (and likely will) you may want another pass to add density but maybe not, who knows??

 

I noticed in your blog you were kind of maybe/maybe not on meds or other preventatives. I would strongly encourage you to consider Finasteride and/or Minoxidil along with a good scalp and hair care regimen like Nioxin/Nizoral. I opted not to use Minox because of the messy regimen but have been taking Finasteride since HT # 2 and have noticed a small amount of regrowth so I believe it may help me hang on to the native hair I have left and maybe stop the sides and back from receeding further downward. Something to think about anyway!!

 

Congrats to you on your procedure with Dr. Shapiro. Please keep posting your updates............great to see other's progress.

[Bill - Seemiller]

Reversethecurse...welcome to the forums. I had a double take at the name because there is another member (who hasn't posted for awhile) with that name...so it took me off guard for a minute and then I realize...oh, a different guy. Well, the name definately applies though doesn't it? We all want to "reverse the curse" after all.

 

Thanks for sharing your experience with us.

 

I do have some concerns though...and maybe I'm misreading this...but I notice you have some 6 hair grafts? Hairs normally grow in ones, twos, threes, and rarely fours, but I never heard of hairs growing in sixes, unless this doctor is using minigrafts which has me a bit concerned. Are you sure you have this correct?

 

Regarding your question, everybody is a little different when it comes to the timeline of when things occur, but typically most start around 2 weeks and finish around 1 month post op.

 

I hope this helps.

 

Bill

[reversethecurse]

Yeah - i seemed to remember that there was someone else with that name too, i actually tried to change my screen name in my profile but i can't seem to do it.

 

Yeah - he said that would raise some eyebrows. They were "DFUs" (double folicular units) - these were used on the crown towards the back where thicknesss was the main concern. Instead of cutting the FU into a 2 and a 4, it was used as a DFU unit of 6 - some of them may have been 5's - it's not exact. As you can see there were only 207 of those - basically those are on the crown near the bald spot with 2's and 3's mixed in between them.

 

The hairline is of course, mainly 1's and then 2's and 3's behind them etc....

 

Thanks for your feedback and concern!

 

Also - per the previous post, i am continuing Propecia.

 

Anyone use MSM with any success to speed hair growth?

 

Thanks again.

 

scape

[hairbank]

rtc-

 

I used MSM for the first 7 or so months after HT #2 and I do believe it will help your hair grow faster......................what it will NOT do is speed up growth of your newly planted grafts. They will start sprouting when they start.....no sooner.

 

If nothing else........MSM is good for the joints so take it anyway. You can pick up a 2 months supply (maybe 1 month, don't remember for sure) at Walmart for around $7. I was taking 3000mg per day.

[Bill - Seemiller]

RTC2,

 

I figured I'd add a "2" on your name so I can differentiate in my head .

 

I have never heard of DFUs before and I'm not sure what his basis for creating them were/are. Perhaps he thinks this would add density while minimizing trauma to the scalp? Personally, I think anything outside of the natural 1-4 follicular unit grafts might cause the appearance of plugginess...especially if the number of these grafts were greater. Did he give you a reason for doing this? He could have just made more incisions and inserted the 3 unit follicular unit grafts in more incisions. I'm sure bigger incisions had to be made to accomodate such a large double unit graft.

 

I've been using MSM since day 1 post op...only about 4 weeks post op now. I used it for my second surgery also...truth be told, I don't know if it did anything for me or not...but I figured it can't hurt...so I'm doing it again anyway...especially since the second HT started to grow in about 2.5 months. Of course, the first started around the same time and I didn't use MSM. Either way...it's worth a try. I actually got a 4 month supply for about $7.49 from GNC because they were having a sale. Normally it would have been about $20 or so.

 

Bill

[reversethecurse]

Cool - i'll pick up some MSM - couldn't hurt.

 

As for the DFUs - I added a close up on my weblog of the crown area - it doesn't look pluggy to me - Dr. Paul said that if anyone has questions about this, they should ask him about it - he figured that it would raise some questions.

 

Take a look at the close up - I can't tell the FUs from the DFUs. There is one spot where the hairs appear to be growing into each other in a little cluster - i'm a bit concerned about that, but other than that, i'm happy with the results so far.

[hairbank]

rtc-

 

I hadn't heard of DFU's before your post either but if Dr. Paul was okay with doing what he did I would think it'll be fine. Given the Shaprio Clinic's reputation, I'm sure they wouldn't place the grafts anywhere if there was a chance for a less-than-solid result.

 

I'll look forward to seeing your updates.

 

Happy growin'!

[Bill - Seemiller]

rtc2,

 

I agree, I don't see anything that looks pluggy. That is interesting about the one smaller cluster of hairs...but wait it out with time too and see what the end result looks like. It could be that the slightly red scalp underneath the cluster is exaggerating it. Of course, maybe it's due to DFUs or hair grouped closer together...but I'm not sure.

 

I'd love to hear Dr. Paul Shapiro's comment on why he used DFUs, perhaps he's be willing to post here? I think it would benefit more than just easing my curiosity...I'm sure other eyebrows will be raised if not already...not necessarily badly...but raised nonetheless.

 

Bill

[reversethecurse]

I did a search and Dr. Paul Rose (from Tampa) mentioned using them in one of his posts about getting high density. I think he used to work with SMG - maybe it's something they've pioneered. I agree that SMG has a great rep and that's why i'm not too worried. Will keep everyone updated with my progress.

 

thanks!

 

rtc2

[reversethecurse]

Hey guys - where's the best place to buy Nizoral and Nioxin? Also - the Nioxin products seem to have several "stages" or something - what exactly is the regimen to follow?

 

TIA -

[the B spot]

Hey guys-----

 

I have not spoken to Dr. Paul Shapiro, other than a brief hello, but in speaking with Ron and Matt about using larger "naturally occurring" grafts this is the underlying thought:

 

1. There are simply some grafts that grow so close together, it is impossible to separate them (sub-divide) without transecting 1,2, or 3 of the hairs. ie-- a six hair graft "cut" with intentions of getting 6 "1's" or 3 "2's", but only ending up with 2 or 3 grafts instead of the original 6.

 

2. Regardless of instrumentation, Doc's cannot take 1 or 2 hair grafts and get them closer together than a "naturally occurring" 3,4,5,6 hair follicular unit. What I mean is that these hairs grow so close together, that all of hair(s) itself seems to exit the scalp from the same point. That is what differentiates a mini-graft from a naturally occurring follicular graft. Mini's HAVE to be split, because significant tissue exists between 2,3,4 hair grafts (think larger incisions vs. .6, .9, 1mm)that would result in a "pluggy" look. A naturally occurring graft would likely use a slightly larger incision, but the hairs contained in the graft would be so close together, say 1.1mm incision required, that even if a doc placed 1 hair grafts with a .6 incision in a group of four, he or she would not be able to get them closer than the 4 hair naturally occurring graft.

 

The thought is (in the core or crown) that when the hair grows out, it will spread and provide more coverage. Imagine a 5 hair graft surrounded by 1 and 2 hair grafts in a tight section of scalp. Should provide some good coverage, but sound like a lower density.

This is like the 50 1 hair FU's versus 25 2 hair FU's, which is more dense? (NOT HAIRLINES)

 

Anyway, the point is, these larger grafts (for lack of a better term)or hair groupings exist naturally on a persons scalp, so they should exist naturally in the crown or mid-scalp without any difference in appearance, etc...

 

I hope that Dr. Paul will answer the questions and perhaps correct any mistakes of mine, but to my knowledge, that is the idea behind these larger hair groupings.

 

BTW, I had quite a few 5 and 6 hair grafts that had to be cut down, otherwise they would have looked like mini's. I think it has a lot to do with the individual.

Hope this helps!!!!

Congrats on a Great Looking surgery!!!!

[Bill - Seemiller]

B-Spot,

 

Thanks for the detailed post on this. It makes sense. I just never heard of naturally growing 5 or 6 follicular unit grafts before. I guess you learn something new every day! I'd definately like a confirmation from Dr. Paul if he sees this post

 

Bill

[Dr. Paul Shapiro]

Hi

This is Dr. Paul Shapiro and this is my first post in the hair transplant forum. It is a great forum and I would like to thank Reversethecurse for posting his web blog. I am sorry it took me a week to post this explanation of DFU's (Double Follicular Units) but as I have typed up my responses I realize how difficult it is to explain this concept in words. After you have read my explanation if any of you have any further questions please feel free to email me at pshapiromd@shapiromedical.com or call our office.

As you all may know I am Dr. Ron Shapiro's brother and I have been working with him for the past six years. In those six years I have gone to most of the IHRS meetings, and I have visited many of the well know hair transplant doctors to observe their surgeries. In those six years I have seen many changes in hair transplantation. When I first trained I was using #15 sharp points to make my incisions and a session of 2,000 FU's (Follicular Units) was considered a large session. Now we cut our own blades down to .6 mm for the one hair follicular units grafts and many of our session consist of 2,000 FU's and it is common for out sessions to go up to 3,000 FU's.

As the sessions have become larger and the blades have become smaller the use of DFU's have largely been ignored. At Shapiro Medical Group we believe that DFU's have place in hair transplantation. In certain patients DFU's can be used to give a greater appearance of density in the central core area when compared to using the same number of FU's alone. When used correctly DFU's are undetectable and have a completely natural look. Also, DFU's give us the potential to achieve higher densities with fewer total grafts. We only use DFU's in patients who have more advanced hair loss so this technique is only appropriate for men who have a baldness of class 4 or greater.

I would like to thank B Spot for his summary of DFU's as it is a complicated concept. What he has described is what we would call follicular families not DFU's. The terminology of what to call certain type of grafts is confusing and many physicians get confused about the terminology. .

I would describe a DFU as a highly refined micro graft. Using the microscope, we are able see follicular units that are close to each other and can cut them into DFU's On the average these DFU's have 6 hairs in them and if they are trimmed well there is very little epithelial tissue on the sides of the graft. The DFU's can be so small as to fit into incisions cut with 1.1 or 1.2 mm size blades. But often I have to use larger blades to make the incisions. DFU's are never used alone, I always place FU's between each DFU.

Using DFU's I believe we can create a greater illusion of density using the same number of hairs then if we use FU's alone. Going back to the basics in Hair Transplantation we always have to remember that all men have a limited donor supply and that most men prior to balding had a hair density of 100 FU/sqcm. In men who have type 4 to 6 balding we rarely have enough donor hair to cover the balding area with even 40 FU/sqcm. In all transplants one of our goals is use a density of 20 to 40 FU/sqcm to create the same effect as if one had 100 FU/sqcm. A more detailed discussion density can be found on the Forums Educational pages or on the Shapiro Medical Groups website in the consult resource pages.

When someone's hair starts to thin we notice the thinning because we can see the scalp under the hair. Prior to this ones hair is thick enough to block the light going to the scalp. The contrast between our hair and the scalp is the main reason we notice that our hair is thinning.. The more light that gets through to our scalp, the greater contrast we can see. If you can imagine a DFU with its 6 hairs fanning with 2 to 3 hair FU's around it you can see the potential to block more light then just 2 and 3 hair FU's alone. How we place the DFU's and FU's are critical to get this effect. DFU's are only appropriate in certain patients with the right type of hair characteristics. They work will in patients with fine, straight, hair that is lighter in color. If a patient s has course, dark hair, there is the potential for the DFU's to look pluggy Also DFU's should never be used near the hairline.

DFU's do give us the potential for achieving a higher density in the central core then using FU's alone. As B spot mentioned the space between the two follicular units in a DFU is much closer then we can normally place hair. But since we have a limited donor supply of hair to work with we are usually placing the same amount of hair in the central core area whether we use DFU's of FU's alone. We are mainly using the DFU's to create a greater illusion of density.

An added benefit to using DFU's is that I can move more hair using less incisions in less time. On average a DFU has 6 hairs. I usually use 200 DFU's in a case which would mean I am moving 1,200 hairs. It would take 400 three hair FU's and 600 two hair FU's to move the same amount of hair. I do believe the sooner we get the hair from the donor strip to the scalp the better it is. I am not saying that this time saving is the reason for doing DFU's but just an added benefit. Our large sessions are taking 6 to 8 hours and just cutting of an hour is easier on the patient.

In summary I believe that in a select group of patients, DFU's s have their usefulness. In these patients DFU's can give better "coverage" then FU's alone by creating a greater illusion of density. At present I would say that 2% of my patients are candidates for DFU's. In the vast majority of my surgeries I use only FU's and my incisions are made with .6 to 1mm blade.

I hope this helps explain DFU's and why I use them. It will be great to see Reversethecurse transplant as he progresses.

[the B spot]

Thanks Dr. Paul!!!!

 

I appreciate you taking the time to really explain what/where/why/how you use DFU's.

 

I had hoped that you would be able to shed greater light on the question, because sometimes an explanation is better straight from Doc!

 

Hopefully, this clears up any confusion/apprehension about your methods and approach!!!!!!!

 

Thanks Again!!!

J

[Bill - Seemiller]

Dr. Paul,

 

Thank you very much for your detailed explanation of DFU's. I think the logic makes sense...and I would agree that placement of these DFUs would be everything. Allow me to ask you a few additional questions if you don't mind.

 

1. What classifies a patient as being a candidate for using DFUs? Since only 2% of your patients are candidates, there must be some exceptional (stand outish) characteristics that you determine their elligibility.

 

2. A devil's advocate question if I may: How would transplanting 100 6 hair DFUs in a certain circumfrance create greater density than 200 3FUs? To me, it seems like "6 in one half a dozen in the other" (almost literally I might add). I know when Dr. Hasson performed surgery on me, he did what was called coupling with some of the remaining singles, in the middle section. The explanation I got there was that the density would be the same (which appears logical to me) but it would create less trauma to the scalp due to fewer incisions in the scalp. So if you wouldn't mind explaining how the same number of hairs would create the illusion of more density. Perhaps I am answering my own question...but perhaps it's simple....strategic positioning?

 

Anyway...thank you for your time and I look forward to your response.

 

Bill

[bayscholar]

Thanks Dr.Paul, very helpful in making sense of what DFU really are.

[Dr. Paul Shapiro]

Hi Bill and Happy Thanksgiving to All

 

Billerso, I always welcome any questions and devils advocate questions are always welcome because they are the ones that make me think the hardest.

 

I would like to answer your question # 2 first.

 

Strategic positioning is important in how we create the illusion of density in hair transplantation surgery whether we use FU's or DFU's I also believe the number of hairs in a graft does make a difference in how much light it can block. We can never place two 1 Hair FU grafts as close together as they are in a 2 Hair FU. In a 2 Hair FU the hairs can fan out and will block more light the two separate one hair FU grafts. Does that make sense? Thus I do believe that five 2 Hair FU grafts if placed correctly can block out more light then ten 1 Hair FU grafts. This principal of blocking light is the basis of how we plan a hair transplant. Sometimes we want the maximum light blocked as in the central core while other times we may not want as much light blocked as in the hairline. We believe it is better to have larger 3 and 4 hair FU's in the central core then using 2 and 1 hair FU's there even if we ended up with the exact same number of hairs. DFU's are just an extension of this principal. Most physicians agree that larger grafts block more light, but the problem is that large grafts can also look pluggy. DFU's are a larger graft that if used correctly can give a greater appearance of density without looking pluggy. So using DFU's is not exactly 6 in one half a dozen in another. But I do have to be careful in how I use DFU's. They only work well in the central core area, and should be only 10 to 20 percent of the total grafts used in a surgery. Only certain patients are good candidates for DFU's. This leads me to the answer of your first question, who is a good candidate for DFU's in a hair transplant surgery.

 

The ideal person to use DFU's is one who has thin, white or light blond hair and when there is little contrast between a patients hair and scalp color. In these patients a FU with one hair hardly has any effect. DFU's with 6 hairs in these patients almost never look pluggy. On the other side of the spectrum, patients with dark, coarse, hair are not good candidates for DFU's. In these patients DFU's could look pluggy, however there still may be some cases in which DFU's might be used in these patients. Many patients fall somewhere in the spectrum of an ideal patient and a risky patient for using DFU's. For example, Reversesthecurse, has fine, straight, hair which makes him a good candidate for DFU's. But his hair color is light brown, not white. In my assessment there was not a very large contrast between his hair color and his scalp color making him a good candidate for DFU's. When using DFU's I also have to consider what area of the head I am going to transplant and how many grafts I will use for the procedure. DFU's are not useful when I am transplanting the hairline, temporal peaks, and crown or in patients who have a lot of hair in the central core area.. Also I don't use DFU's if I am doing a small case of less then 2,000 FU's because I will need the natural distribution of 1,2,3, and 4 hair FU's normally found in the donor strip. DFU's do now work well in patients with poor donor density because the yield of FU's will be low and the space between the FU's are too large to make a good DFU.

 

Using the above criteria, I would say that in my practice 5%-10% of the patients are ideal candidates for DFU's. Another 5%-10% are good candidates for DFU's. I know I stated that I do DFU's in about 2% of my patients. I was just stating a number off the top of my head. When I went back and reviewed my charts I use DFU's in about 10% of my patients. Sorry for that error. I guess I use them more often then I thought. I most likely could use them in a greater percentage of patients, but there are many patients who insist on FU grafting only. They are afraid that DFU's will give them a pluggy look and in those patients I would not force them to use DFU's because regardless of whether I use DFU's of not I will get good results. Using either method the hairtranplant will look natural and full, but in certain patients I believe using DFU's will give a greater illusion of density in the central core.

[Gorpy]

Thank you so much for that great information Dr. Shapiro. After reading it, it occurred to me that Pat, the publisher of this community, just received 101 DFU's from his procedure with your brother. Pat does not have the characteristics you described. I'm very interested in DFU's because I think they might give me some added density. So please don't take this observation the wrong way. My hair is lighter and finer than Pat's. Maybe I'll talk to Dr. Keene about DFU's.

[Bill - Seemiller]

Dr. Paul,

 

(I will call you this as you requested to differentiate from your brother who I refer to ad Dr. Shapiro - though I should probably refer to him as Dr. Ron because I know thiere is another Dr. Shapiro somewhere else - who would have thought the name Shapiro would be so popular for HTs )

 

Now I'll stop digressing and get to the point. Thank you for taking the time to explain on that. Your explanation was very thorough and hard to dispute (which of course would not be my point in asking the questions anyway). Your answers are well founded as they should be. I suppose "plugginess" was my primary concern about DFUs, but I can see that between strategic positioning, certain hair characteristics, and hair to scalp color contrast, etc. that there is a case where DFUs could have merit.

 

Obviously, there would need to be continual discretion placed on when to use these DFUs...where the number of them remain smaller to add density. I believe (though I'm stating this with no medical knowledge nor seeing these first hand) that the use of too many DFUs could create the pluggy effect on the scalp. Correct me if I'm wrong, but I also believe these DFUs would have to be used in a place where there is already a good amount of density to cover over, either that, or certainly not all within one location...once again, coming back to strategic positioning of these grafts.

 

So...if I may further pick your brain:

 

1. What would be the best strategic positioning of the DFU? As I suggested above, it doesn't seem that clumping them all together would be ideal and might create plugginess, so what is your strategy for placing these DFUs to minimize/eliminate plugginess yet create the illusion of greater density?

 

2. Is there a limit of how many DFUs you would use on a person's scalp...whether that number be a percentage or a number of hairs?

 

3. Another way to ask my first question perhaps, so if you address this above, feel free to ignore it here...but approximately how far apart would you place DFUs from one another so that the HT doesn't appear pluggy?

 

If there are other factors at stake here too that I am missing, please correct me.

 

Thanks again for your time and contribution to this forum.

 

Bill

[Dr. Paul Shapiro]

Gorpy

 

I am sure Pat would not mind me disclosing that his hair is actually very white but he dyes his hair. This leads me into mentioning another reason why we use DFU's. In patients with very white or grey hair it is very difficult to see the hair bulbs. Hair transplant doctors have tried various methods of dying the follicles to make them stand out and these methods help a little but it is still difficult to see the bulbs. Thus the chance of transecting a bulb of even cutting and unseen bulb out of the FU is possible. When we cut a DFU we know we are not cutting any of the hair bulbs between the two FU's. Even the best hair transplant technicians most likely will cut off bulbs in white hair patients. We believe by using DFU's we avoid some of that problem It may only mean saving 50 hair follicles, but every hair follicle counts.

 

 

Secondly, we do use DFU's in patients with darker hair. Pat's hair color is a dark brown and his texture is not fine, but not thick. DFU's can be used in patients like Pat if used correctly. Pat has already had a number of hair transplant surgeries and we know all the hair in his central core is transplanted hair. Thus we have a good base to put the DFU's between By placing DFU's between the transplanted hair we can get the desity effect I spoke about earlier without any unnaturalness. There are cases we even use DFU's in dark hair patients. It depends on the individual case. But in general we use them on patients who have fine light colored hair with little contrast between the hair and the skin.

 

You may be a candidate for DFU's and I am sure Dr. Keen will be glad to discuss the pros and cons of DFU's in your case with you.

 

Dr. Paul

[Dr. Paul Shapiro]

Bill

 

You are correct that only a portion of the hairs should be DFU's. As I already mentioned, 10% to 20% of the hairs are used to make DFU's. The actual number depends on the size of the case, the donor density, etc. I have used from 150 to 400 DFU's in different cases. It just depends on the case. In most cases I don't even know exactly how many DFU's I will use until the strip is taken out. I will then save a portion of the strip for DFU's. When the cutting starts the technicians can give me an estimate of the number of FU's I will get from the strip and the percentage of 1,2,3,and ,,4 FU's the stirp will yield. Based on this information I then decide on if I will use DFU's and how many.

 

Then density and distance we place the DFU's vary from patient to patient. I have never actually measured how many mm is between each DFU that I place. I would say on the average I place about 10 DFU's/sqcm. What is important is that the DFU's are not transplanted alone, but with FU's around them. Depending on how many FU's I plan to place around each DFU and if I plan to use 2, 3 or 4 hair FU's around the DFU also determines how far apart I will place the DFU's.

 

I hope this answers your questions and sorry I can not give you a more exact answer. And I understand your concern about a pluggy look but I can't give you any more exact answers then the ones above. What I can say is that the proof of a good result using DFU's is in the pudding. We will follow Reversethecurse's progress and see how his transplant looks. And as I said DFU's are not for everyone. Many patients ask the exact same questions you ask, and if in the end they are still concerned about a pluggy look with DFU's I will only use FU's in their transplants. Either way the patients will end up with excellent results. There are some cases I believe that DFU's are so superior I will insist on using them. For example a man with very white hair, a good, dense donor, and a large central core to cover. But in many cases the difference between a surgery with or without DFU's is not big enough to make me be insistent on using one method or the other, even if I believe the DFU's would give a better illusion of density.

 

Dr. Paul

[Bill - Seemiller]

What I can say is that the proof of a good result using DFU's is in the pudding.

What I can say is that the proof of a good result using DFU's is in the pudding.

 

Dr. Paul,

 

I think it's funny that you used that phrase especially when talking to me, because I've been posting that all over the forums these last several months...it's sort of been my catch phrase if you will. So either you used it on me purposely knowing that I'd "get it" or great minds think alike . Of course, therefore, I agree with you...it is the results that will speak for themselves

 

Thank you for all the explanations...I am definitely more educated as a result of your posts and I trust that other patients or perspective patients reading have gotten something out of it as well.

 

Bill