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Old 03-15-2009, 09:01 PM   #11
Winston
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That was a great radio show tonight! Dr. Bauman sounds like he's way ahead of the pack. I enjoyed listening very much and Im interested in seeing more pictures of this procedure.
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Old 03-16-2009, 12:45 AM   #12
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I second that Spencer. The bald truth is the best show on radio today! Your take on life is so right on! Thank you for helping all of us to feel that weíre not crazy to worry about our hair!!!
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Old 03-16-2009, 03:34 PM   #13
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Any new FUE device will get my full attention, but I have some serious concerns about this one.

The first, of course, is that I have not seen any significant results on actual grown out patients. This will no doubt come in time, but at what price to how many donor areas?

The second is that it utilizes a spinning punch, and while this may facilitate the procedure for the doctor, it also subjects the grafts to TORSIONAL forces which are detrimental to FUE grafts.

Third, this device employs suction in such a way that the partially scored graft is sucked all the way through the spinning punch, THEN through some tubing, and THEN into a catch jar of some kind. Needless to say, living tissue doesn’t care for that sort of gauntlet.

Forth, and probably the largest concern I have, is the chance for transection and trauma as the splayed out follicles come in contact with the spinning punch as it gets sucked down the entire length of the punch.

In some patients the diameter of the graft at the bottom is conveniently the same as at the top, but this is not the case most of the time. If it were, FUE would be a breeze. Instead, most of the time, the grafts splay or spread out at the bottom, which is why an FUE punch should never be driven all the way down to the bottom of the dermis.

If this device, as described, scores down to a certain point with the spinning punch and then relies on suction to pull the graft free from the bottom, then any part of a splayed graft is going to get cut off or at least nicked pretty significantly by the spinning punch. And even though the graft may not APPEAR to be damaged, it may well be dead.

Fifth, suction means “air-flow” and that’s deadly to a graft. It doesn’t matter if the air-flow is toward or away from a graft, flow in any direction WILL desiccate the graft. No ands, ifs, or buts. It will do it every time. I personally believe graft desiccation is the number one cause of poor growth in hair transplants of any kind. Again, once such grafts are rehydrated they may LOOK alive, but are long dead.

There is no doubt that a certain percentage of grafts will grow despite the drawbacks of this machine. There is no doubt that a few patients with that "lucky" combination of characteristics will benefit from it significantly.

I also have no doubt that such patient results will be over-hyped and promoted unethically.

But such patients would be better off if their doctor just practiced and perfected “standard” FUE and didn’t look to lean on this machine as the easy way out. It isn’t.

If the three main detrimental forces of FUE are:
1. Torsion
2. Traction
3. Compression

Which of these forces does this machine address?

Definitely not numbers one and two. Perhaps number three since there is less compression required due of the use of suction, but this gain is more than outweighed by new losses due to desiccation and the grafts gauntlet ride as its sucked down the tubing.

These are some major concerns that someone not versed in FUE would know to look out for. It would be very interesting to read how the manufacturers of this machine would address these issues.

Dr. Feller
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Old 03-16-2009, 08:02 PM   #14
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Dr. Feller, Dr. Bauman and All--- I love the ingenuity to try and get "better" using the amazing technology at our fingertips. It is a testament to a select few who strive to get better every day, regardless of past success.

With that said,
I think the person doing the extractions must still have the "feel" to mimic the angle of the follicle, regardless of what tool is used. Once Dr. Bauman explained he used this machine with a .8mm punch/extractor, he confirmed my suspicion that his personal skill has a tremendous impact on the success of the NeoGraft's use.

For those who have not seen a .8-.9-1.0mm punch in use, let me tell you it is HARD WORK and exhausting. It is very labor intensive, and is very draining physically and mentally. This is why Dr Feller, Dr. Bauman, and others continue to stress the fact that FUE is not a miracle solution, not everyone is a candidate, and donor management is just as important as ever.

Because I have not seen the machine in use and Dr. Feller already established some concerns I will refrain from any additional technical debate.

However, perhaps if this machine can obtain VIABLE grafts on a majority of FUE candidates, it has the potential to reduce the overall stress of the FUE scoring and extraction process and allow additional clinics to offer FUE. That remains to be seen.

On a potentially negative note, technology such as this is often very cost prohibitive and would likely pressure any clinic to do larger than advisable sessions in an attempt to recoup costs. That could have a very damaging effect long-term on the patient and reputation of the clinic. Dr. Feller's point about unpracticed doctors performing FUE is certainly legitimate when viewed in this light.

Spencer, Dr. Feller, Dr, Bauman-- perhaps we could put together a "meeting of the minds" to observe the viability of the machine and exchange ideas and techniques on FUE in general. Given much of the ignorance and over-selling of FUE, it would be a step in the right direction to have well respected doctors come together to share ideas. Just an idea!

Take Care,
Jason
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Old 03-16-2009, 08:26 PM   #15
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Brilliantly articulated Dr. Feller! I enjoy reading your posts and listening to you when you call Spencer's show. I like how you couple your engineering background with medicine, providing a unique perspective that not alot of people have or can conjecture on their own.

We engineers are cool, aren't we? :-)

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Old 03-17-2009, 06:38 AM   #16
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Jason,
Your post hit the bullseye.

I would be up for a meeting of the FUE minds, but most FUE practitioners don't want to participate for various reasons: They're too busy, they're instruments and techniques are proprietary, they don't want to be watched and critqued during FUE surgery, bad blood, past rivalries, etc...

I don't believe in this neofue tool, but I'm more than willing to go out of my way to see it in action and report on my observations on this forum.

TJ,
It's rare to see the words "Engineers" and "cool" used in the same sentence. Thanks.
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Old 03-17-2009, 08:18 AM   #17
Jeffrey Epstein, MD
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I too greatly welcome the dialogue that goes on between esteemed colleagues and educated lay people. In the 18 plus years of being intimately invoved in the plastic surgery and hair restoration field, I have been witness to an endless number of new technologies- most of which were released with great fanfare, only to be discarded a year or two later as the touted advantages prove to be short-lived. Examples: Dr. Rassman's hair implanter carousel; thread lifts for facial rejuvenation; and Thermage skin tightener. Even the initial laser hair combs and Rogaine, two innovative treatments that now have a potential role in treating hair loss (at least LLLLT hoods such as Revage that seem to be the best system and perhaps the hair combs) got released initially with such incredible accolades that the hype was much more than the reality - all in the name of making money, and perhaps secondarily in helping patients. Maybe when selling cars or perfume, hype and marketing should take precedence over data, but when it comes to medicine- surgery in particular- restraint must take precedence.

I have not seen the NeoGraft system in use, other than a promotional /educational video put out by Dr. Bauman in conjunction with the very company that plans to benefit from such a device- and I cannot think of anyone better than Dr. Bauman to get the message out about this device. What concerns me however, is that there is, quite frankly very little evidence that this device is superior to standard techniques of FUE- in fact, having the delicate hair follicles exposed to suction and air flow, I have similar (but unproven) concerns as Dr. Feller- about the viability of the hairs. Second, in my practice, my FUE grafts after dissection are typically placed into recipient sites 0.5 to 0.6 mm in size, occasionally 0.7 mm- while the automatic planter for the NeoGraft works with recipient sites 0.8 mm and larger, unless I misunderstood. Smaller recipient sites allow for denser packing and more impressive results, and potentially less scarring.
I rely on my carefully trained team of assistants to allow me to harvest (then implant) as many as 1800 FUE grafts in a single 8 hour procedure- equal to apparently the peak number of grafts that the NeoGraft can obtain. Then for planting, these same assistants work with me to place the grafts into recipient sites that I have made with 0.5 to 0.7 mm recipient sites. This is the artistry of hair restoration, and no machine is going to take the place of individual surgeon artistic skills and passion and the skills of talented assistants.

I greatly look forward to seeing some data - reliable US released data by respected peers such as Dr. Bauman- before making any conclusions other than the NeoGraft does seem to allow for the obtaining of FUE grafts with the use of fewer assistants. This is not an advantage for me at this time, but I do hope that the device does improve the results of FUE hair transplants.


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Old 03-17-2009, 07:46 PM   #18
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Dr. Feller, Dr. Epstein, Dr. Bauman and all,

It’s great to see truly passionate experts discussing any possible advancement in the field of surgical hair restoration. Baldtruthtalk.com was created to help better educate and to empower, not only the hair loss consumer, but the hair loss physician as well. Education is an ever evolving process and I’ve learned over the years that while asserting opinions is important for obvious reasons, asserting them in a doctrinaire or dogmatic manner usually creates a less than comfortable environment in which to learn and to share ideas.

In my view, until it’s proven that the the Neograft machine damages grafts, terms like “detrimental forces”, “torsion” and “desiccation”, are simply words used to make a theoretical point.

Dr. Feller, your insight holds great significance and is a needed part of this dialogue, but it’s equally important to understand that there might be more than one way to skin a cat. I think Dr. Bauman’s track record speaks for itself, as do the track records of all of your esteem colleagues in the IAHRS.

As Dr. Epstein so eloquently eludes to, there are very few in the field who have been as effective in promoting state of the art surgical hair restoration to the mainstream consciousness as Dr. Alan Bauman. I see this as just one of Dr. Bauman's considerable contributions to the field.


I look forward to continuing this dialogue in a professional and mutually respectful manner.
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I am not a physician. My opinions and knowledge concerning hair loss and its treatment are based on extensive research and reporting on the subject as a consumer advocate and hair loss educator. My views and comments on the subject should not be taken as medical advice. Always seek the advice of a medical professional when considering medical and surgical treatment.
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Old 03-17-2009, 08:35 PM   #19
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Beautifully put Spencer.
Loo,king forward to seeing more from Dr. Baumann on this device.
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Old 03-18-2009, 12:16 AM   #20
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Very well put Spencer. I think this machine looks like it might have real value and I donít think Dr. Bauaman would risk his reputation on a machine that didnít work.
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