View Full Version : FUE Donor Area Healing With ACell 3 Mo. Post-Op

06-14-2013, 10:37 AM
The following 4x4 photo illustrates the value of ACell in FUE donor area healing. I circled a follicular group for reference on all four photos. The third photo is a composite of the extraction photo overlaid with transparency over the 3 month post-op photo. At the very least, ACell reduces hypopigmentation. Notice in the photos the near complete absence of scar tissue at the donor sites. We typically check for follicle regeneration at 8-12 month post-op.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
[URL="http://The following 4x4 photo illustrates the value of ACell in FUE donor area healing. I circled a follicular group for reference on all four photos. The third photo is a composite of the extraction photo overlaid with transparency over the 3 month post-op photo. At the very least, ACell reduces hypopigmentation. Notice in the photos the near complete absence of scar tissue at the donor sites. We typically check for follicle regeneration at 8-12 month post-op.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
Cole Hair Transplant Atlanta
Phone 678-566-1011
Cole Hair Transplant
Phone 678-566-1011

John P. Cole, MD
06-14-2013, 11:02 AM
No question here. 66 to 75% regrowth.

06-14-2013, 11:08 AM
No question here. 66 to 75% regrowth.

This is changing the game! Good to see there are doctors around the world and in the US now all working for donor regeneration!

Keep it up, we are rooting for you!

06-15-2013, 09:21 AM
Using that 4 hair follicle as a reference point I certainly do not see 70% regrowth but bare skin where the extractions sites were made and that is very evident with the extractions made immediately around that reference point. Maybe someone else sees something different.

06-15-2013, 10:43 AM
Using that 4 hair follicle as a reference point I certainly do not see 70% regrowth but bare skin where the extractions sites were made and that is very evident with the extractions made immediately around that reference point. Maybe someone else sees something different.

I agree. I would like to see the regenerated hairs circled.

Other than that it looks very nice! Absence of scars is a great improvement!

John P. Cole, MD
06-15-2013, 06:32 PM
We will show you in an overlay next week. This is a complicated donor area and it is easy to confuse one's self because the groups are so large. Never the less, there are 12 extractions in 1 sq cm. There are four blank spots . in one of the blank spots, there may be one or two peripheral hairs growing. This may represent growth in 9 of 12 extractions, with only a partial regrowth in one. Alternatively, it could be 8 or 12 regenerations or 66%.

John P. Cole, MD
06-15-2013, 06:37 PM
by the way, simple donor areas have tight bundles with fewer hairs per group. this is a wide spaced hair grouping that probably contains more than one follicular unit per grouping because a follicular unit by definition contains no more than 4 terminal hairs. Complex donor areas are more difficult to evaluate, but they are ideally suited to this study where we wanted to evaluate regeneration when a larger punch was used. One could have alternatively used a 0.8 mm punch and taken small pieces of each follicular grouping. That was not the study design in this case. we wanted to evaluate regrowth of completely intact larger groupings rather than hope to see regeneration of smaller bites of each group. that would have been almost impossible to evaluate in this particular patient.

06-16-2013, 06:29 AM
Thank you for the reply and look forward to seeing the overlay.

John P. Cole, MD
06-16-2013, 06:57 AM
At about 4 weeks we could see hair growing in 5 extraction sites. At 5 weeks, the healing was so good that we could see only 3 distinct extraction sites without hair. Of course this was with the hair long. We elected to go to the three month mark to shave the hair down again so we could see the extraction area clearly.

In the first 5 weeks we saw only 1 or 2 hairs in each extraction site that was growing hair except one that hair multiple hairs. Actually, i would have been happy to see 1 or 2 hairs following the removal of 3 and 4 hair groups, but what i found at 3 months was multiple hair growing the the extraction sites. This very positive news.

I think now the goal will be to do a comparison using one side with our Acell/gel and photopolymerizing liquid on one side and nothing on the other side or plain gel with no additives to compare the healing.

06-21-2013, 05:43 PM
Hey Dr Cole,

I have a ?, it's a little derail so I apologize but it does concern Acell. I was in your clinic March 29th, did about 1300 grafts and did receive Acell, I believe over the donor and recipient areas.

The donor area was business as usual, but the recipient area was honestly minimally red, especially in the crown. I followed the post OP to the 9's, is this indicative of that or should I be concerned. I can see minimal growth forming and I know where we're at in the grand scheme, but all other procedures I was pretty red for awhile afterwards. This time, no redness. Is this due to Acell being awesome?

Hoping the same method of this regeneration is what I received. I know everyone is different, but it is promising. See you soon for scar revision.

John P. Cole, MD
06-21-2013, 06:31 PM
I certainly appreciate all the feedback I can get regarding any procedure. Years ago, I could learn from all my patients regarding what works well and what does not work so well. Then patients began to come from all over and it became more difficult to evaluate each response to treatment.

PRP is supposed to deliver growth factors that promote improvement in the quality of existing hair. If you have received one of these treatments within the past year, we will be contacting you next week to evaluate how you responded in areas that we did not graft or in short term responses in areas that we did graft. We expect you to do better in areas that we grafted long term in areas that had existing hair even if PRP has no benefit.

If you have pre-existing hair, we expect these areas to improve about 8 to 12 months after a procedure without PRP. If you improve sooner, it suggests a PRP benefit. If you improve in areas that we did not graft, then that suggests a PRP benefit. Then there is the possibility that you improved due to PRP and grafts over a span of time.

Combining PRP and Acell should result in a greater probability of improvement without grafts, but they do not guarantee such improvement. What we need to know is how many respond favorably. This is why we will be contacting you beginning next week.

Then again, you might heal faster with PRP. This is common especially with a 1X PRP concentration. Then we also feel you will get more growth factors with a 5X concentration of PRP and this might help improvement in yields and in the quality of existing hair. A high cell count improves the probability of swelling. Swelling is not necessary to induce hair growth. What we want is a low cell count and a high platelet count. Only the Angel system allows this sort of differentiation.

Now getting back to your question. Does Acell reduce redness? Does PRP improve healing? Might my last procedure not heal as fast as the more recent procedure?

We feel that Acell improves healing long term. We also believe that Acell can prolong redness, but Acell may not. We believe that PRP speeds healing in many, yet some may not heal as fast with PRP. PRP should improve healing in most, however.

In general, I have heard that my technique heals faster than most. Small incision sites heal faster than larger ones. Still we never expect anyone to grow hair before the 3rd month and at 3 months only 30% will grow. If you have pre-existing hair, donít expect an improvement for 8 to 12 months and then plan on 12 before your hair looks fuller. Only those that were totally slick bald will see results at 3 months. Those that started with hair in an area that is grafted will not see new growth. What they will see is an improvement in coverage after 8 to 12 months. Your hair will suddenly appear fuller. It is similar to planting seed in a mature field of crop such as corn. You will not see the new corn stalks, but after they reach maturity, the whole field looks fuller. Alternatively, if you plant crops in a fresh area of dirt, you can see the new growth immediately. Once that crop grows, however, you canít see new seedlings emerge because they are hidden. Such is the case with crops planted in mature fields. What you see is a thicker filed of crop only after the new seedlings grow to a height even with existing mature crops. Such is the case with hair. Only after new grafts grow to a style-able length will you see them.

Then there is this particular case. I studied this result last week. Then I studied the overlay we did beginning this week.

Here is my response. At 4 weeks I saw 5 grafted sites growing hair. Each site was still a little bit apparent most likely because Acell stimulates vascularity. I could see hair in pink extraction sites. Thus, we know 5 of 12 sites were growing hair at one month. Then, 3 months later I evaluated the area. My belief was that 3 sites had no growth and one site might have a single or a two hair re-growing. Then I looked at the overlay.

With the overlay, I feel there are 6 sites growing, 3 sites with no growth, and 3 perhaps. When I look at the overlay, I feel it is off slightly so there may be 7 or 8 sights growing and 4 or 5 sites not growing. The good news is that there area sights growing. The bad news it is hard to be exact at this point.

Yes, Acell can prolong redness, but in the long run, Acell can improve the overall donor area and perhaps also the recipient area. Still, we need to study this all further.

06-22-2013, 04:30 AM
My own case is very well documented with what I would say is the quickest healing I have seen in watching the forums for years and viewing many cases. Some of my photos clearly show hairs growing as early as 8 weeks in the recipient area. I am 50 but my body can perform the same or better than the majority of 20 year olds mostly better. I have found this to be all diet related and as the old saying goes “let medicine be thy food and food be thy medicine”

Nutrition is truly the key.

06-22-2013, 05:59 AM
As far as regeneration goes. Dr. Bisanga has gone into my lateral hump area 3 times to harvest what is left of my scalp donor and to be quite honest the area is as thick as everÖÖÖ.hmmmmÖ..regeneration from superior nutritionÖÖÖÖ..I donít have documentation so you see where we get into some hairy issues if I were to start making that claim.

It has been stated on these forums for years. Extract every follicle from an area 1 square inch then letís see if one has regeneration without attributing it to some normal hair cycling. Surely you can find one volunteer for the sake of science.

06-22-2013, 06:12 AM
Dr Cole, Thank you for being so active here! Also-
Thank you so much for your hard work and ongoing dedication to the use of Acell.
I have been a huge Acell advocate way before it was even considered as a possible treatment for hair loss.
The 4x4 sample photo on this thread is an eye opener !!

John P. Cole, MD
06-22-2013, 10:31 AM
Topcat, I agree that nutrition is very important. it's probably the one area that we've over looked in hair restoration surgery. I think a well balanced diet obviates most issues, but an improved diet is probably very important. Glad to hear that you have not lost density from harvesting. I measure cross sectional trichometry on all patients with hair that is long enough to measure. This is a measure of 4 square centimeters of hair surface area. basically, it's like taking a box of spaghetti noodles and measuring the surface area of the bunch. a box with more noodles will have a larger surface area. A box with larger noodles will have a larger surface area. I measure the surface area after FUE and i also have alot of data on those who have undergone strip surgery. in a nut shell, surface area of 4 sq. cm of hair decreases alot more after strip surgery than with FUE.

One of the things that happens with FUE is you tend to get white dots on the scalp. these are very easy to see and I most likely could find them on you Topcat. One thing that makes this case so difficult to evaluate is that they white dots are absent. That's probably part of the Acell affect.

Many hair restoration patients are very concerned about diet and health. I've not seen diet alone regenerate hair. Still, I think it is worthwhile for you to describe your diet.

Thanks, Artista. Many times it is the forum members that alert us to new ideas to be quite frank with you. We had 5 sites growing hair when they were still pink and easy to find. We will work on circling this week when we get time. I do think this is important. It's just not as easy as it seems

06-22-2013, 10:48 AM
Thank you for the nice answer. I think my diet would be too long to go into, why I eat what I eat and when I eat it. I would say that I do consume much more cholesterol than most and Iím sure as a doctor with your training you would highly advise against this as that is part of your training and the information you are exposed to which would be understandable.

Personally I believe most of the medical training is controlled by those at a much higher level for the benefit of those that are in control much like many other things in the world and most doctors canít think outside of that box and even if they tried that are quickly put back into line.

My only question is the suggestion of the 1 inch or 4 sq cm area having all the follicles removed and showing regeneration. This same question was posed to Gho well over 10 years ago and we still have not seen an attempt so of course it is very normal to ask the question.

Iím sure you can appreciate someone just getting to the point it does not mean one is being rude. We are all men here equal in my eyes. My main concerns here and why I continue to post is to see honesty and highly skilled work that doesnít harm the patient.

John P. Cole, MD
06-22-2013, 11:20 AM
Topcat, there are different ways to harvest follicles. One way is to take part of a follicular group. Another way is to take all of the follicular group. sometimes, this is easy. Sometimes, the donor area is not conducive to this. If you harvest part, the donor area will look more natural, but you will move fewer hairs because you leave more in the donor area. I do this often and this is what Dr. Gho has been doing in my opinion. He suggests that he is taking only part of the group down the middle of a group. There is not instrument capable of doing this. If the is able to do this, he should sell the tool because he could make a fortune.

Thanks for the diet information. Dr. Bisanga was one of my top surgery techs when he worked for me. He did not have a license in the USA so I started him as a surgery tech in hair transplant surgery in about 1998. We started him off in practice in Cyprus because he had alot of talent. You found a good one. Both he and I have always liked to eat so talking about nutrition is a good way to get both of us interested in the subject.

06-22-2013, 11:36 AM
Okay well I feel the question has still not been answered. If Acell is promoting regeneration that show a 4 sq cm area with all the follicles removed by way of fue apply the mix and show the regrowth.

Of course I think Dr. Bisanga is highly skilled and has natural talent and I also like him as a person. He is very easy going and very easy to get along with which is something that is personally very important to me. Of course you are highly skilled that is well known and I have always told others the same and nothing different regardless of what others might think I am honest.

The highly skilled guys should all get together of which there are very few and start their own club. No need for me to mention who I believe belongs in that club but it would make it so much easier for other patients. The forums could be eliminated and we wouldnít have all this nonsense that goes on and I say this only as an outside observer on something that has had a tremendous effect on the direction of my life but in reality most of it has been good for others not so much. I still see too many being misled by those that they believe are doing good as they keeping honing their image as being the good guys.

John P. Cole, MD
06-22-2013, 10:15 PM
i don't think you could draw the line in the sand any more clearly regarding what you want with respect to Acell and regeneration, Topcat. Will do my best. Just recognize that while I have some computer talent, it is not where it needs to be on this one. I'm sort of in the hands of others in my office and some are not local. I have to catch them when I have time. In that I harvest all my grafts rather than use laymen like the robotics guys or Dr. Shapiro, I just don't have the face time I'd like to have with my computer geeks.

Yes, Dr. Bisanga is quite good. It is interesting that two on this forum came out of that class of assistants. One was Dr. Bisanga and the other was Dr. Mwamba. Both are now running very respectable practices in Belgium.

I get assistants all the time that worked somewhere else and they want top dollar. Most are not very good to be honest with you. It's pretty clear that their physician before me never bothered to monitor their quality of work. Most have to unlearn the bad habits and then learn how to do it right. Drs. Bisanga and Mwamba started with me, did a great job, and carried over their skill set and experience to their own practice. Both learned to the direction to make recipient sites by placing grafts in sites I made. Both learned what a graft should look like by knowing what I expected. Most physicians never cut many grafts so they don't have a clue what they should look like. Then most have never placed many grafts so they don't know that aspect either. Drs. Bisanga and Mwamba learned the basics first. It helped make them top tier physicians later on. The best physicians know how to cut their own grafts and how to place them. If they physician does not know this, how can you expect him to place levels of expectations on their staff? Honestly, they can't. It's like owning the airplane. If you have never flown it, you don't know when the pilot is doing a great job or when he is prone to kill you and all the passengers. Physicians have to get in the trenches first.

Regarding quality, I agree with you that we have set higher standards, but my personal belief is that the only true way to get a top notch quality control system is to have a physician who knows what should be going on making the judgement about who is good and who is not so good. The current system is like having a blind person judge a beauty contest. The judge can put their hands on you all they want, but you need one with vision, perspective, and insight to judge true quality. When I do repair work on patients who had surgery by physicians who are on various recommended lists, one recognizes the limitations of the current system. We are certainly much better off than we were in previous years, but we have a long way to go.

This is especially true with FUE. This is the hot topic buzz word today, but there are plenty of guys offering FUE today who have no formal training in FUE. They have few results. Many use laymen to harvest the grafts. Donor areas are not something to play around with. You can't go out and buy more hair after a surgery tech chews through it with a mechanical punch. FUE is similar to cutting grafts in that respect. If the physician does not know what he should be getting out of a donor area, then the surgery tech will produce what ever he wants and the physician will be happy. The only problem is that 30% of the hair might be destroyed and no one knows any better. This sort of thing is going on all over the world right now. Medical boards seem to be turning a blind eye to the whole matter based simply on the fact that no one is raising any alarms to this. Most likely, it will take some sort of class action lawsuit against practices that allow laymen to harvest grafts with a surgical punch to put an end to all this.

I'm all for great results. If a physician knows what is in a donor area and he knows what should be coming out of the donor area and he monitors follicle injury, then I'm tolerant of using techs to harvest grafts. I'm not a fan of it, but I'm tolerant of it. If the physician does not know what is in a donor area, if he does not know what should be coming out of the donor area, and if the does not monitor the follicle injury, I'm completely intolerant of this practice. The same goes for robotic surgery as this is predominantly done by physicians who have no experience doing FUE yet they turn the practice over to layman monitoring. Recognize that in one recent study with the robot that over 50% of the grafts had at least one transected follicle and almost 16% of the grafts were completely transected. Because the grafts simply disappeared the robotics folks just disregarded them and their response was that no one looks at grafts that closely. One can't calculate transection rates when grafts disappear, but one can estimate that about 30% of the hair was transected in that case. Patients can't look that closely, but physicians should even though it appears they are not. I think that if patients knew that follicle transection rates were so high, they would not allow a robot to do their surgery. Then again, people often seem to surprise me. Perhaps they are tolerant of such sub-optimal work.

Now I make my own equipment based on my own personal very high standards and expectations with regard to FUE. My standards are based on over 10 years of experience in FUE and over 5000 cases of FUE. I made several prototypes prior to using a single mechanical extractor on many patients. The reason i delayed using one was that the mechanical extractors could not match my manual methods. Only when i made one that could match my manual methods, did I begin to use it. I offer instruments for sale, but this is not to say that anyone can use them. Those with no talent can't make a paint brush create a masterpiece. A robot is designed to make someone with no surgical talent create a masterpiece. The problem is that a head moves every time a person breathes. A robot can't keep up with that. We are not screwing on nuts on a stationary object. We are trying to hit a perfect spot on a moving object. what is more, the objects are all different. Some have 3 hairs. Some have 6 hairs. Some have 2 hairs. the exit angle is always changing. Robots can't keep up with this.

The bottom line is that if you want good hair transplant surgery, find a good surgeon. Don't expect a robot to make up for a lack of skill in hair transplant surgery.

When I was in the 3rd grade, I wanted to play the trumpet. Those in the music department told my mother that I had no ear for music, but I really wanted to play the trumpet. My mother bought me a used trumpet and I tried for 2 years. I tried really hard. I practiced all the time. I was so bad that i was sent to the back yard to practice. In two years I learned to play one song and not well. That song was Mary had a little lamb. After two years, I recognized that my music teachers were right. I had no talent for music. I moved on. Now my daughter can play the violin very well, but I now know that I could never do that. Some physicians have no talent for hair transplant surgery. Robots certainly don't. When you don't have the talent, you just need to move on. Otherwise, all you will do is butcher your project just as I did with mary had a little lamb. Butchering a song is one thing. Butchering a patient is simply unacceptable. If your talent is so bad that you need to rely on a robot, just don't offer the surgery. Stick with strips if that is what you are good at. If you can't do FUE, my equipment is not going to make you successful at FUE either. My equipment is the best on the market for FUE. However, just as a Stradivarius violent is amazing, it can't make someone with no musical talent such as myself into a maestro. Remember, you can put all the lipstick on a pig that you want, but at the end of the day, it's still a pig.

06-23-2013, 04:50 AM
Thank you for the reply and although I’m not a surgeon nor do I work in this business I don’t need to in order to agree or understand as for me this is just plain common sense that applies to many things in life but most don’t seem to get it.

I have posted many examples in my own way over the years to try and help others understand but I’m not always sure the message gets across. I have even taken a picture of a wooden gate my neighbor built and hung…………lol…………..I have watched him for years. He does not know how to use a level or a square the most basic tools of the carpenter so of course one can’t expect him to hang and build a gate that will look good and work well. I agree you either have the talent or really do everyone a favor and move on to another line of work. You either have that vision in your mind and can see it or hear it or you can’t.

I also agree with the bottom up approach of understanding and becoming good at anything and can use so many examples in my own life. One must always master the basics and that mastery can only come through repetition and what most don’t get is that it is almost endless repetition over and over again both physically and in your mind when others would least expect it that person is practicing in their mind, behind the wheel, at the dinner table, the waiting room, wherever. Does everyone have this ability or the desire to want to be that great, the answer of course if no.

Finding out who has the natural talent along with the vision and determination to be really great is the most difficult part of researching a hair transplant once again my own experience in life outside of what goes on in the ht industry is that most people are very lazy. It’s not enough to only have the talent or to be surrounded by people along the way that help you as we all have been helped by others in some way at some time in our life but one needs to have that inner drive to just want to be the best. Where does this come from, I’m not quite sure but for me personally I can use any situation negative or positive to become better, to use it as a driving force and not give up. From what I have observed most that have tried fue by hand have given up………too hard for them. So why in the world would someone choose a person that gave up so easily or did not have the skill because now they have a robot…………sorry but I agree, no thank you I’m looking for someone with determination.

I also believe although it might be hard for many you need to be a people person to be in this business. It’s important to the patient and it’s important when one wants to surround themselves with a high quality high caring staff. I remember reading the experience of a patient from that Cyprus clinic about 10 years ago. Dr. Bisanga did not perform a procedure on this patient while the patient was at the Cyprus clinic but what he did the gesture that he made really stood out in my mind. It can only be described of an act of a very kind, gentle man that cared and had a big heart. These too are important traits.

Sometime it’s almost like I have too much life experience in the area of working and dealing with people as my work has required it and I can give so many more examples of so much that matters when trying to figure out this industry and who is honest and who is not. It has gotten much easier over time.

I look forward to seeing updates and thank you for the reply.

06-23-2013, 05:10 AM
Please feel free to call or email me with any questions. Ask for Chuck

Is it allowed to ask a question ...

...concerning this ...hmmm... should I say "photo" or "photos" - if you understand what I mean with "photo vs. photos" ....

06-23-2013, 08:54 AM
I think we can all thank many around us for some of the skills and good qualities that we have may possess. I always thank my dad for giving me such a strong work ethic and just general drive to want to excel at whatever I choose to do.

Someone I think that is not given enough credit is Dr. Woods. Regardless of whether he chose to share information or not as I believe had I been in this same business knowing how many of the vultures in it operate I might have done the same. What I do really respect about him is that he is not afraid to be politically incorrect and state exactly how the industry along with the forums and some of their operatives work. For that it seems that he has had to pay a very hefty price at least that is the way it appears to me but I can respect a man with a set of balls.

I think the biggest move forward in this industry will not be a new technique or process but when these handful of really talented doctors trying to do the right thing put any ego they have aside and decide they have had enough of what they see going on and form their own group. I would love to see this happen and have nothing to gain accept the satisfaction of seeing these wannabes but will neverbes out of business along with those that work in this industry and can only be described as snakes in the grass. I watch and hear what some of them do and it really turns my stomach because I was that young guy once. These young guys think they know but they really don't understand what is going on and it's not as easy as simply telling them.

Maybe one day it will happen.

John P. Cole, MD
06-25-2013, 03:46 PM
Very interesting, Topcat. Yes, we both agree. You have to want to be good at something. You have to have the talent. Then you have to get the experience. When Dr. Bisanga worked with me in his last year, we worked 7 days a week three weeks out of each month for one year. He got the time to become very good and he wanted to be good. He was a very hard worker and he helped me out when I needed his help the most. So did Dr. Mwamba, but Dr. Mwamba was with me through 2005. He got a ton of exposure to FUE. Both did everything I ever asked them to do and they never complained. They always put the patient and the result first. I always demand that of my staff, however. If they are sloppy in their work, they don't last long. Those that we keep are very dedicated to their work. They work tirelessly to produce the best possible result. I would never have succeeded without my wonderful staff over the years. I demand alot of them, but they always come through. My belief is that each patient's hair loss and restoration or repair situation is the most important thing in their life at that moment so we have the duty to give each case our absolute best. If my staff is ever having a problem in life, I always ask them to leave those problems at the door of the office and deliver their best effort for every patient. If a problem in life prohibits them from doing their best effort on any given day, they know that they have my blessing to stay home because nothing can interfere with the quality of work each day. I never had that issue with either Dr. Bisanga or Mwamba. They were both wonderful assistants and they have both become outstanding hair restoration surgeons.

This is my best attempt to show the extraction sites. It is interesting that when i went back to the extraction site overlay, one of the sites i thought had nothing clearly had at least one hair. Often you can't see the difference between one hair and two hairs in a photo. I often prove this even under my 6X magnification by trying to extract a single hair unit only to find that almost all are at least two hairs. With a photo, you simply can't tell if it is one hair or two.

The overlay did not fit perfect, but it is close. Size of the images is a little different.

Also, one site I was certain had a hair probably does not.

Remember that we had 5 hairs growing in 5 extraction sites at about 5 weeks. At about 3 weeks I put in the tattoos because it was getting hard to find the extraction sites because they were healing so well. The tattoos were not placed exactly like the 1 sq cm area that I harvested from. I placed them only so i could find them.

The blue line represents the tattoo marks. All extractions were within these marks. The green circles represent definite regrowth sites. The purple represent the definite no regrowth sites. The red represent sites I'm not certain about. I am least certain about the red circle to the bottom left.

06-25-2013, 03:59 PM
Well I have been observing this industry for a very long time. I have spoken to many people over many years, listened and have taken notes along with having almost a photographic memory. I can easily draw back into my collection of information and pull out all kinds of facts but I will leave that for another day.

I will say this from my own life experience. I have had many teachers along the way and I have developed many skills along the way. My practice of many of those skills can only be described as having passed those of many of my teachers . That is life sometimes and many of those teachers smile when they see me do my thing and that makes me feel good and I’m sure they feel the same.

Thank you for the update. I can’t say I’m convinced but I say that with no agenda and only honesty. I will keep watching.

John P. Cole, MD
06-25-2013, 04:16 PM
Well stated. Every teacher wants their students to advance. While teachers advance after students move on, one always hopes to learn from the student. There are so many ways left to advance this discipline. No one person can do it all on their own. A student that stands still is not advancing the discipline. There simply are too few who step out of the box and come up with improvements.

When I first started in this field we had plugs and mini grafts. They looked terrible. A handful stepped out of the box in an effort to create a more natural result. The vast majority of physicians were much slower to adapt, but over time they adapt. One always wonders whether this adaption is based on aesthetics or patient demand for a more optimal outcome, however. The good ones keep advancing and always stay a step ahead of the vast majority. It is the little things that make the greatest difference.

06-25-2013, 04:40 PM
Sure nothing wrong with advancement but patients who know very little need to be better informed and extremely cautious. If we were to believe in each and every advancement we would all be tattooing our heads, having robotic or endoscopic fue or who knows what else. The majority of the advancements over the years are gone because they were in fact crap and were only meant to advance the numbers forward in someoneís bank account. So of course one needs to always move forward with extreme caution when listening to many of the carnival barkers in this industry.

John P. Cole, MD
06-25-2013, 05:21 PM
That's true. If you have been in the field long enough, you know when it sounds too good to be true. With anything new, you need to exercise a degree of caution. I know from experience with body hair that I didn't believe it would work. Then I tried it and the first few cases were great successes. Then I had some major failures. One needs repeated success to pass judgment.

Many probably have some application such as the tattoo. Tattooing has limited use, but then again we really need to follow it a long time to make sure that it does indeed fade with the newer pigments. I can't imagine someone will be happy with blue dots once their hair turns white. Then there are those that rarely if ever have any benefit such as scalp reductions, plugs, minigrafts, flaps, and balloon expansion. Even body hair works well in about 25% of the patients. Beard hair works well, but it sometimes looks like beard hair and that can be an issue for many. Come to think of it, even hair transplants aren't the best idea for all patients. Strip scars can create long term problems for many. FUE does not work optimally for all. I thought of endoscopy a long time ago to replace strips, but who wants a bald zone in the donor area. I think it is worth seeing what happens long term with this method to replace FUE. I'm glad people are innovating. We all want a better aesthetic result. The one thing we can't do is replenish a donor supply. That's why I'm hoping for continued success with Acell and hopefully stem cell therapy later on. Stem cells have not worked out yet. With the Acell bandage we apply, there will be issues coating a larger area and it is costly to apply. It is a cost I will have to eat for now and in limited trials. One trial certainly does not suggest future positive results. Also, we might be replacing three hairs with one hair in some sites as only a handful of sites appear to have multiple hair growing.

Next we will have to do one box without Acell and one box with Acell to evaluate if there is any firm improvement with Acell as opposed to placebo. We will also try to do a better job with photographs going forward as we learned a great deal about their importance in this single patient trial.

06-25-2013, 06:45 PM
Stem cells in my opinion are a long way off. I have watched Geron for about 20 years and the FDA has a way of crushing anyone regardless of the amount of data they provide or money spent if it is a threat to the status quo. It is only when the status quo benefits that it will come to market and as of now the money is being made in current treatments not cures. Although they were working with patients suffering spinal cord injuries it still poses a threat to the greater market. Sometimes we can see the same in hair transplantation when something that is actually better comes along it becomes a threat to the status quo, thankfully they donít wield much power.

Acell experimentation is not even on the FDAís radar as long as you are not trying to cure cancer you are safe. If no harm comes to the patient then it just becomes a matter of proving something of which I have not seen much.

Advancements come in many ways. I had an interaction recently and without going into great detail I was so impressed with this person I had to let them know. We conversed briefly and he passed on the title of a book he gave his daughter when she was 12 and it made a huge difference in who she became as a person. I in turn purchased that book and also passed on another book to this same person that I regularly keep several copies of as I believe it is one of those types of books of which there are many that can advance someone as a person so I tend to hand out a copy here in there for people I think are special in some way. We both advanced as people during that interaction which can sometimes be more important than advancing in the engineering of ideas.

I read a book by Daniel Golman it must have been almost 20 years ago. There was a short story in it that I always remember and it can relate to hair transplantation as it is a team effort and as a patient I want the whole team to not only be great at what they do but happy that they are doing it. So as I have written advancements come in many ways. I will cut and paste the story below from ďEmotional IntelligenceĒ as Iím sure many can learn from it.

In his book, Goleman relates the story of Melburn McBroom, who was a domineering leader, with a bad temper. The problem with this combination of emotional deficiencies was that he also happened to be an airline pilot. In 1978 as McBroomís plane was approaching Portland, Oregon to land, he noticed a problem with the landing gear. He decided to maintain a holding pattern as he obsessed about the landing gear. His co-pilots watched as the fuel gauges approached empty, but they were so fearful of their leaderís wrath that they said nothing. The plane crashed, killing ten people. This story is told in training courses to enforce the need for teamwork, open communication, cooperation, listening, which leaders with high emotional intelligence foster.

Donít want to get to far off topic so I look forward to further updates.

If you get a chance take a look at my posting in the "off topic rants" section. " Leadership in the HT industry. I thought it was worth posting but unfortunately I think most will miss it.

John P. Cole, MD
06-25-2013, 07:54 PM
That is a good story. One could also theorize that with a problematic landing gear in certain circumstances, it was more prudent to hold the course looking for a solution than to put the plane down especially in cross winds and down shears. Who lived to tell the whole truth? As you suggest, a team approach is of benefit unless the rest of the team has a sure death option. In which case, a more cautious approach might have been optimal provided that the fuel gauges were accurate, which they often are not. I owed a plane for many years and I know that small things make a huge difference between life and death. One time I was flying from Charlotte to Atlanta in the rear of an 8 seat plane. I looked out the left side and noted that the left side engine had stopped soon after take off. I made my way down the aisle to the ****pit and told the captain that the left engine had stopped. He was the most gracious person you could ever expect to know. He turned around and told me to sit down and shut up. He worked for me, but I could tell in his tone that he was aware of the situation, the situation was serious, and he needed to focus on landing a twin engine with one engine working. A twin with one engine wants to turn in circles. He did not need teamwork. He needed focus. He landed the plane and we all survived. Sometimes those on the team think they are of help, but they are not really. Do you honestly think that those about to die because there was no fuel simply shut their mouths so they could be the focus of someone’s book? I don’t. I think they noted it, they were scared to death, they froze, and somehow they must have lived to tell the tale. No one dies because they are afraid to say the fuel is empty when the alternative is to live and say there is no fuel.
Let me tell you another plane story. I was in the ****pit one night flying into weather. My pilot had us on course to land without visibility or Instrument Flight Rules (IFR). Suddenly, the ****pit came alive from the tower asking us to say position. My pilot stated his position and the tower came back to pull up immediately because we were 7 miles off course. Still we continued to descend. Finally, I turned to the pilot and said “they said to pull up because we are off course” He did. We came back on the IFR and landed safely. My pilot upon landing told me he was “shitting kittens”. Don’t suggest to me that someone about to die is not going to take corrective action because they are afraid of persecution over death.

People express concerns out of fear that the actions will result in serious negative consequences such as death. They do not express concern because they are not sure that their beliefs are potentially disastrous. One does not express concern when they are not certain. One does express concern when they are certain. One does express an opinion when one has an idea based on experience that an action will result in a negative consequence. If one does not have such experience, one is not likely to express a concern.
Then there is the gentleman approach where you do not say anything because you want to be pleasantly professional. This is an approach common in medicine where someone disagrees, but they don’t say anything out of professionalism. Actually, they do say something, but only under their breath, but never to the guilty party. This is pretty common in medicine.

In my clinic, I am tough. I expect miracles. My staff knows what I expect. They respond. When I make a slight mistake, they correct me. Does that sound funny? I’m that really tough airline pilot, yet should I make a single mistake, my staff knows and they let me know. That is what you are talking about. Teamwork. My staff knows that my expectations are so high that they will not allow me to make a mistake however so slight. We watch out for one another, but they are so compelled because I am so compelled. While I cannot imagine a team allowing a plane to crash as they watch the instrument gauge run to no fuel, I can imagine a compulsive team making certain that no one makes a single mistake. Humans do make mistakes. A well greased team prohibits even the slightest error even by their leader. My job is to make sure they know what is right and what is wrong. We watch each other’s back, but ultimately, the quality control is in my hands. They know I don’t tolerate mistakes and they have the same perception of my work.

Topcat, I think you are a work of art and a breath of fresh air. You are right. i need to look at your writings because I am certain they are full of wonderful insights and analogies. I think they could very well make us all better people. You have made me think and perhaps I need to think deeper. Deep thought is never a hinderance when your work holds the welfare and happiness of others in your oh so limited human hands. Thank you for your comments. My rebuttal is simply off the cuff and could change as i continue to contemplate your valuable lessons.

06-25-2013, 08:09 PM
Well I laughed at your response as it was very good and very interesting. Some of it I would disagree with but we all base on views on different experiences.

I have spoken to countless repair patients as I’m sure you have. Something some of us have in common and is kind of unique is that same fear of authority that kept us from taking appropriate action to save ourselves before it was too late. One story in particular from a patient relating his experience during a flap procedure struck a nerve for me and was especially eerie.

When I sat in that chair 28 years ago and caught my first glimpse of Puig I knew with no doubt I was in extreme danger but I was frozen by the fear of what I perceived as authority so you see sometime this does happen as I remember it very well like it was yesterday. I guess there are always two sides to the coin and I am aware of that also through other personal experiences but I will spare you the stories.

Even today when I hear from the patients who got switched over to strip at the last minute because the doctor told them they were not a candidate for fue I understand what they must be feeling when it happens and I despise a doctor that would do this to a young man or a rep that would represent him.

John P. Cole, MD
06-25-2013, 08:45 PM
I think we could swap spit (stories) all night as you seem to be full of them.

In the repair side of hair, there are over 30 years of bad, and when i say bad, I mean really bad work. I can recall listening to Martin Unger back in 1998 tell about how he offers chocolate or vanilla. Chocolate is a scalp reduction and vanilla is mini grafts or plugs. The patient asks what he recommends and he says a scalp reduction. Patients listen to what he recommends even though long term it offers the worts possible outcome. Patients always want what we recommend. When patients tell me to do what i think it is best, my first response is that they would never sit in the chair and tell the hair stylist to surprise them. People know what they want so start with what your goals are. What are your primary goals and let's proceed from there. Just last week I had a 26 year old tell me it was a 4 cm to 5 cm hairline. I sent him home. i was not going to build it. We gave him his money back and we failed to recognize his goals in advance. Had i built the 7 or 8 cm hairline he needed, he'd have been unhappy. Sometimes it is better to make them unhappy with what you can't do because long term it's a disaster waiting to happen.

Carlos is a dear sweet man. He would never intentionally do any wrong to anyone. Still he did primarily because he was not a forward thinker or a progressive thinker, or an evaluator. if one continues to do bad work and see it as good. eventually you harm enough people to carry that stigma the remainder of your life. How anyone could put plugs on a scalp or do scalp reductions for 30 years and not see the error of their ways, I have no idea. I became interested in hair restoration only because men wanted hair so bad that they would be willing to look like circus freaks to have it. How anyone could continue to offer such appalling work for years without ever thinking twice about it baffles me. I think it all goes back to the same old acceptance thinking that precludes advancement in the hair restoration industry as a whole. Think about it. For 30 years no one thought plugs and reductions were bad yet then suddenly things changed. Why? New docs simply said these results are unacceptable. Still, why did it take 30 years. I have no clue. I knew right away.

Yes, I have heard all these stories and much worse. I still hear how patients are told their strip scars will be pencil thin. That's fine unless you are the average which is not pencil thin or even if you are pencil thin but you marry two different hair growth angles and two different qualities of hair.

John P. Cole, MD
06-25-2013, 09:15 PM
Ok, I'll look for words of wisdom tomorrow. I have to go to sleep now. I have 10 lab puppies that need to exercise their bladders at 3 am and then again at 6am. Training hunting dogs is a full time, part time job. Then I need to feed my ducks, quail, and pigeons. Goodnight. It's been fun.

06-26-2013, 02:45 PM
Okay good enough. One last thought, would putting about 30 or so 4 mm plugs into this hairline be the work of a dear sweet man. I was 23 and thought I was adding a little hair to the temple regions. I now realize at the age of 50 I can tell someone in the twenties pretty much anything and they will believe me. Why someone would intentionally steer them in the wrong direction because of money is beyond me, maybe they are just wired differently.

Money does strange things to people and I see it on these forums daily as I see it in life. When I watch the many that come here and tell me how good of a person they are I think they are trying to convince themselves as they are constantly repeating it almost out of guilt.

I rarely bring up my own past as it really doesnít matter but what does matter is what these guys that are in there 20ís are being told.

http://i271.photobucket.com/albums/jj131/topcat911/hairline23.jpg (http://s271.photobucket.com/user/topcat911/media/hairline23.jpg.html)

06-26-2013, 04:07 PM
I worked in the night club/bar business for over 25 years and I can tell you 90+% of those employed were to varying degrees alcoholics. It sometimes made it difficult for me to work in that industry but I always stood by my principles. People would laugh at me when I would have trays of wheatgrass or 50lb sacks of carrots delivered but they accepted me over time.

The HT industry in my opinion is the same 90+% dishonest people to varying degrees and working in various capacities so most don’t get what I do especially when I derive nothing from this except the satisfaction of doing something good. Time to start the 10% club where having principles matter.

John P. Cole, MD
06-26-2013, 07:52 PM
I think you made your point exceptionally clear and I agree. There are all sorts of nice people in any industry. How about the good old father Obrien down at the parish who gives you communion on Sunday and then gives your son something else on Monday. Nice does not insure someone is honest, decent, professional, or good. Nice men lie, confabulate, conspire, and ruin lives all in an effort to improve their personal situation. I could not agree more. Sometimes nice people ruin lives out of a degree of ignorance, however. Take the case of Thalomide which was sold over the counter by the nice pharmacist for morning sickness in the 50s only to discover soon there after that over 10,000 children developed birth defects. In the case of Thalomide, however, it did not take more than a couple of years to put two and two together and regulate the drug. Prior to this drugs were not thought to cross the placental barrier even though the effects of alcohol on the fetus were well known by then. The whole medical industry was ignorant.

In your instance, I have no compassion for the man who did this to you. You need to bring this up over and over again because it drives home a very significant point.

In 1958 Norman Orientriech published the first well known paper on hair transplantation when he described moving plugs of skin from the donor area to the bald recipient area. Orientriech gained notoriety out of this and he has been honored by hair restoration physicians many times over. He gave us the Orientriech punch or the tools of the trade. Now, the story I heard from a researcher that worked for Orientriech years ago was that Orientriech did not develop the either the technique or the punch. He learned the technique while in the Navy from another officer, took the method and the tools, and then put them all out there for the world to see under his name once his teacher died. According to this tale, he paid off the family of the true originator. Now I have idea if this story is true or false. What I do know is that if Orientriech, the inventor, did not develop the tools or the craft, then this is one reason the hair restoration industry stood stagnant for years with nothing more than plugs. True innovators do not sit pat with one technique. They are always looking for a better way. If you were never a true innovator, you were more than happy to keep the same old method around for decades with the tools in your name.

So, how long did plugs stick around? From 1958 until the mid-1990s this was the "gold standard". In 1988 Limmer first described total follicular transplantation. It was not until 1991 or 1992 that we saw our first 1000 graft strip surgery. Now, you know how resistant the medical industry is to change. First, they usually don't think there is a better way. Then, they don't think the better way is better. Then, only under market forces (patient demand) do they want to learn a new method. This transformation takes about 10 years. That's about how long it took for FUT to become main stream and about how long it took for FUE to become main stream.

My question to those who practiced hair transplant surgery from 1958 until 1990 is why on earth did you keep putting plugs on the heads of people when they looked so hideous? Why would you do this to a 23 year old when you have been treating patients for 20 years and watching what happens to 23 year olds who begin to loose their hair? One cannot forgive such a person. If you had been practicing hair transplant surgery since the 1970s as I'm told Carlos had, how could you have missed that 23 year olds with hair loss are the ones who get the most advanced degrees of hair loss. In 20 years, you had to recognize the limitations of the donor area. At the very best, a donor area would yield 350 to 500 (4 mm) plugs and that certainly is not enough hair to conceal the plugs or the bald scalp of a NW 5 or greater. Those who begin to loose in their 20s are more likely to become a NW 5 so prudence should have dictated that you don't do it.

Now if you are 50 now, that means you had your procedure in 1986. Plugs were the gold standard back then. By then, Carlos had been doing hair transplants for about 10 years. He should have known better, but he did not.

I often say that I did not choose hair transplant surgery for a field. It chose me. I had the opportunity to see a number of men who had gone through hair transplant surgery. I asked all of them a series of questions. Why did you have a hair transplant? What do you like about it? What do you dislike about it. The vast majority stated that they wished the result looked more natural, but they preferred having hair over the alternative of being bald. This started my journey in hair transplant surgery with a single goal - give men what they want and make it look natural.

When I began doing hair transplants in 1990, I began by reading what was available at the time. I skipped through what was old and went straight to the sections relating to new technology, follicular units, single hairs, and such. Then I asked to visit a man with 23 years of hair transplant experience and he allowed me to watch while he taught. I was taught many things. One was that hair loss stops at age 35. That is pure rubbish. Another was not to worry about donor area management for the ages. Again that is rubbish. Be aggressive in young men. Again this is dangerous rubbish. He taught me how to build a hairline that looked terrible and was angled improperly. He taught me how to do scalp reductions, which never benefited anyone other than the pocket of the doctor. When I tried to discuss new technology to him, he treated me like the young Dr. Arrowsmith and banished me to the prairie. There was no where to go back then to learn the new stuff. One had to develop it on their own back then. The same was true for FUE back in 2002 when I became infatuated with the technique. The same issues with donor area management, procedure, methods, goals, possibilities, etc. all had to be developed with FUE as they did with FUT in the early 90s.

Now it did not take me long to realize that the gold standard in hair transplants in 1990 was terrible. I never understood why it took those with 15 years of experience such as Carlos to recognize the same.

He was not an innovator. He has always followed market forces. In other words those who learn based on market pressure don't learn new technology until patients stop coming because you don't offer a procedure. Then you learn it. Once you have no choice other than to loose money or learn, you decide to learn. These sorts of followers are not the ones who look at the advantages of new technology. They stick to what they are taught and never budge until forced to budge. They never question how bad things look. To them, it's just hair. The same today is true with strip surgeons. They don't see their terrible strip scars. They don't even understand why you are so distraught about it. "What are you worried about, you have hair on the top of your head" is what they say.

Personally, I like Carlos. That does not mean that I am tolerant of what he did to patients for many years. I have had my share of repair cases from his handy work over the years. Many did not have the money to pay me. Carlos will tell you that his worst advertising is his old patients. He has to live with that the rest of his life. I consider it fair punishment for what he did to young men in the prime of their youth, however. He needs to wake up every day and think of all the harm he did and then remind himself every time he looks in the mirror.

I'll leave this discussion with this comment. In 2005 I applied for an ISHRS fellowship training program. At the time, Carlos was the head of that program. In the program, you had to list an outline of your training in detail with regard to every aspect of hair restoration surgery. One had to deal with donor harvesting, recipient area, etc. Two topics were scalp reductions and flaps. Carlos was always a big fan of scalp reductions. My education on these was very succinct. "They don't work". Carlos denied my fellowship application because I would not give formal training on scalp reductions and flaps. I wasted a 1000.00 application fee along with hundreds of hours of work to put this program together. Still, I was not going to teach procedures that are most prone to damage lives. Carlos and I are still friends, but then again, he did not put 4mm plugs on my forehead. If he had, I might feel a whole lot different about him.

Never stop telling your story. If you don't tell it, people will never know that the vast majority of physicians doing hair transplant surgery have absolutely no idea what a good aesthetic result is. They just do what ever it was that they were taught. There are very few who say, "that looks like crap, let's look for a better way". Then there are also few who say, "I learned a good method, but I'm going to try to do a better job than what I was taught". My job is to teach as many as possible how to do the job right now, because there are not many who will try to take what they learn to the next step. If they learn it wrong, chances are good that they will always do it wrong.

John P. Cole, MD
06-26-2013, 09:45 PM
Topcat, I never looked at your photos before, but I can tell that Brandy got ahold of you too. You went to the cutting edge at the time. I can see why you are suspect of the cutting edge. This lift business was never a good idea. I paid to attend one of Brandy's workshops in 1993. I walked away knowing I never wanted to offer that procedure. I can also see that you've had quite a bit of good work including body hair. Recognize that in 2002 non of this sort of surgery existed in the USA. By the time that Dr. Bisanga went out on his own in 2005, I had already developed all of it and personally trained all of his surgery staff that worked for him in Cyprus. A good hair transplant is a team effort. One does not do this procedure alone and it takes at least one year to train a team. You need a team. You are a huge fan of Dr. Bisanga, and I am too, but I'm curious what aspect of your amazing transformation that he pioneered. There are only two guys that I know of who pulled this rabbit out of the hat. One was Ray Woods for thinking of it. The other was myself for actually doing it. You are a carbon copy of a case I began in May 2003 and that is long before Chris saw FUE. When I began that transformation in 2003 none of this stuff existed anywhere in the world. I had to invent the technique and the tools. We did not show this sort of thing to Chris until the summer of 2003 and at that point all he knew was strip surgery. Did he do something new that I don't know about? If so, I'd love to advance my knowledge.

The Brandy lift elevates hair onto the top of the head at the expense of hair in the nape of the neck, back of the head, and above the ears. You've been stripped out. When you said that Dr. Bisanga had gone into the lateral humps of your scalp many times with no depletion, the first thought in my mind was the Brandy lift which essentially elevates the donor area onto the sides and top of the scalp. In short, the donor area moves superiorly. It was just a bad idea. It also appears that you had the slot correction he was so proud of that put that semicircle scar down the back of your head. Then someone over harvested yoru donor area and left a wide pink scar. Your nape hair is elevated on the back of you head. This is prone to loss over time too. One way I've tackled this sort of thing is to use abdomen hair to create a new nape of the neck.

I'm glad Chris was able to do this for you. I know from experience just how hard a case like this is and how much time it takes. It is good to know someone else can pull off a restoration like this as there are not many who can accomplish a repair like this. You are also fortunate that your body hair grew. It does not always grow. In my experience only 25% of body hair patients get good results. In the rest, you may get some growth, but you can't see it. Beard hair is the exception. It grows to an average yield of 60% and I've seen over 90% with Acell in combination. Of course this was a limited study without statistical significance. Still beard grows well, long, fast and curly. It's the coarse and curly nature that some don't like. So, you have to test beard first to see if patients like it. Your result looks great. I'm sure it's a bit thin because no one has enough hair to do the whole head, but totally awesome. I'm so happy with your result.

Well, I guess my case is a bit different. He had minigrafts on the hairline in addition to the brandy lift. I had to remove all the mini grafts first, but I redistributed them. It was an amazing transformation.

By the way, your conditioning looks awesome. Many doctors can learn from this sort of transformation. Give us the steps involved. In mine, I took out the mini-grafts first and relocated them to the entire front. I also had to take out two and three hair grafts along the temples that had been placed in front of the brandy scars. Removal of grafts with FUE had no been described before I first did it. Then i moved leg hair to the temples, chest hair to the top, abdomen hair to the nape of the neck, leg hair to the scars, and then harvested hair from the lateral humps (top and sides) to the front. I moved leg hair to the area above the ears, white walls. It was a great result. I never moved beard, but beard can be a great source. He did not have much of one.

06-27-2013, 04:34 AM
I am very familiar with Thalomide but I like your story about Father OíBrien much better. Why do they come back those that were victimized and sometimes do the same to others. I have seen repair patients or at least that is what they call themselves come back and profit from this industry any way the can and I know for a fact that they are dishonest because I have spoken to too many and have too many e-mails. But they continue to claim they are just paying it forward, chin up and all that crap. Itís hard for me to wrap my mind around it, itís surreal.

Yes we all have different experiences and I will leave you with this last thought. Alex Jones the inventor of the Nautilus line of fitness equipment was both an innovator and inventor but in actuality he was more of a marketer. What he had claimed was an improvement in actuality was not, in fact one would have been better off lifting a rock as the hormonal effect on the body would have been 10 times that of what he claimed his machines were doing. Many in the industry felt pressured to buy his crap as the demand was coming from the public who didnít know any better and there wasnít anyone around to help educate them. So a lot of time and money was wasted and many are now coming along discovering the old way thinking itís the new way which always makes me smile.

One day I will tell you the story about Leo Stefanos who owned a small candy shop about 6 blocks from where I grew up in the 70ís. The name was Dove Candies. Itís a good story as one could say the final outcome would be exactly where fue is heading if robotics spends enough on marketing. I knew that Dove bar Leo made very well, it was the absolute best in the world no one could touch it and Leo was a good honest man. Today that same bar tastes like sh*t.

06-27-2013, 07:29 AM
Actually the real credit goes to Paul Paraskevopolus he is the one that really spread the word about Leo. None of us would have known as we thought what we were getting was the best. Every time we heard those Good Humor bells we would be running like lap dogs until Paul set us straight. Why did Paul do it, simply the excitement of an eleven year old and I would like to think that the eleven year old still exists in all of us. Paul didn’t care about money he just knew what he knew and he knew others needed to know.

Who would have thought I would be telling that story 40 years later and it would mean something. Makes me really believe we are all here to learn and regardless of our circumstances overcome them and help as many along the way as possible. We really do learn from so many people in our life.

Paul Paraskevopoulus………………thank you wherever you are.

John P. Cole, MD
06-27-2013, 08:03 AM
This is the difference between the Artas extraction sites and a small sharp punch. The Artas uses a small sharp punch that is 1.0 mm and then follows with a "duller" punch that is supposed to be 1.2 mm. They claim this dull punch does not cut skin, it only dilates the 1.0 mm extraction site. You can clearly see from this photo that the extraction sites are much larger than 1.0 mm. Also, as you move to the side of the head, the hair growth angles begin to change from downward (negative) on a Y axis and zero on the X axis to downward on the Y axis and negative direction on the X axis. As this occurs, their dull punch is actually sliding across the skin, cutting a huge ellipse as it goes, and making an even larger wound. This sliding will occur because the punch enters the skin at the angle of hair growth and because it is not sharp, it begins to slide rather than cut. It's also one reason why over 15% of their grafts are completely transected.

If you go to the list of physicians who own an Artas, there is not a single one of them that really ever did much FUE at all. Sure, one guy did one or two smaller cases a month, but that's not really enough to become highly skilled at something. For most, their first introduction to FUE was the Artas. Another bought it only because he could not do FUE, but his assistant could do FUE. He was scared that if his assistant quit, he would loose all that FUE money he was making letting a layman with no formal medical training cut his grafts for him. Thus, he bought an Artas. There certainly is not a single owner of the Artas that I would consider a world leader in FUE. If I were a patient, there is not a single one that I would let do my FUE procedure. Most bought the Artas so they could offer FUE to their patients without so much as a reflection on how poorly the thing operates. They just don't know and the company representatives are not forthright about the true follicle injury rate. Those that do own this machine also use it for marketing purposes. One guy with clinics all over has it on the front of his website. He's the one that told me he was going to buy it for marketing purposes alone and did not care if it worked. He has no idea what a good FUE procedure is, but it's clear that his purpose is to make money. Another physician told me that the Artas was better at FUE than he was so he was going to buy one. My advice to all of them would simply be to let the company build a decent product and then buy one. Until then, they should not offer FUE. Clearly there needs to be a 10% FUE club as you mentioned. There is not a single one of these physicians or their Artas that would be in that club.

I have trained a number of physicians in FUE. Some quite frankly should not be doing FUE because they have terrible hands so I tell them this. I offer hands on training outside the US. Do you think a single Artas physician ever asked me to show them how to do FUE? Nope. Not one. It was easier to just buy the machine without ever discovering what good FUE was prior to making that investment.

I believe that you need to first understand the principals of FUE. You begin by learning manual extraction. You need to know this so that you can understand how to use a mechanical extractor safely. Then you advance to mechanical extractors.

While there are many good engineers working on this project, they have not gotten this thing right yet. I hope they will, of course, because as you suggest, there is too much market pressure on physicians who either are unwilling to spend the time to learn FUE or they don't have the skill to do FUE. Patients are demanding FUE so expect more and more to buy an Artas simply for economic reasons.

John P. Cole, MD
06-27-2013, 08:09 AM
Yes, Topcat, appropriate analogy of where FUE is heading, I fear. I pray I'm wrong.

06-27-2013, 10:03 AM
He has no idea what a good FUE procedure is, but it's clear that his purpose is to make money. Another physician told me that the Artas was better at FUE than he was so he was going to buy one. My advice to all of them would simply be to let the company build a decent product and then buy one. Until then, they should not offer FUE. Clearly there needs to be a 10% FUE club as you mentioned. There is not a single one of these physicians or their Artas that would be in that club.

I have trained a number of physicians in FUE. Some quite frankly should not be doing FUE because they have terrible hands so I tell them this. I offer hands on training outside the US. Do you think a single Artas physician ever asked me to show them how to do FUE? Nope. Not one. It was easier to just buy the machine without ever discovering what good FUE was prior to making that investment.

Patients are demanding FUE so expect more and more to buy an Artas simply for economic reasons.

I spoke with a surgery technician who attended the recent hair restoration meeting in the Bahamas. She mentioned to me that while attending the meeting, two hair transplant doctors mentioned to her, they were considering purchasing the Robot strictly for marketing purposes.

35YrsAfter also posts as CITNews and works at Dr. Cole's office

06-27-2013, 10:14 AM
Thank you for the detailed explanation. Having worked on heavy machinery including having done my share of machining I find it interesting. I found out the hard way as many when entering codes into the CNC one small error can result in a lot of damage. Not very pleasant when the tool slams into the turret head……..lol……….but I didn’t have to pay for those mistakes………..

Yes I have always worked more than I should have and 80 hour weeks were quite common. I found out digging holes can be quite expensive and the one I was digging was rather large…………lol……………never blamed Carlos and only blamed myself for not being smart enough. Nothing to do with intelligence but understanding not everyone was like me. I couldn’t intentionally harm someone so I never understood that for others it didn’t seem to be a problem. Never expected it from a doctor they left that lesson out of my classroom studies.

I was trained by Paul Ward Phd as a fitness trainer for The Health and Tennis Corp of America back in 78 which eventually became Bally’s. Paul didn’t want Arthur Jones’ equipment in the place because he knew it was crap. But Arthur was smarter and took his message directly to the public. Before long the public demanded it and as is often true the public knows very little. Same could happen with the ARTAS so the 10% should probably step up a bit more and educate the public as it is needed. I try but I have already been banned from 2 forums. One several years ago let me know that my promotion of FUE was very dangerous and that I should just move on and good luck to me………..lol………………they seem to be singing a different tune now as do some of the reps, funny how that works. He who pays the piper calls the tune.

I always thought of starting something where the 10% could get together but to be honest I can’t see myself making a dime from this business nor should I. My interests are in the field of health and fitness and I have a device I designed several years ago that targets the core. I have built 2 prototypes over the last 7 years and hope to bring it to market. I know I move slow but it works much better for me. But I continue to post because the building is burning and I don’t like to leave people behind. Trying to put a book together on how the forums work because I find it both bizarre and fascinating.

It’s seems to me as an outside observer that the 10% have painted themselves into a corner and need to do business a certain way which is so sad. I mean I look at one forum where the person advising others actually uploads his own homemade fetish internet porn and I think my god what are these doctors thinking. No one should be making any money in this business except the doctors and their teams. Surely that 10% are intelligent enough to figure it out as they must be a better way.

06-27-2014, 03:48 PM
Dr Cole, so you say that not only a complete new graft grew but it did produce hair long enough to Pierce the skin, all in just 4 weeks? That sounds quite impossible ?

06-28-2014, 06:35 AM
Good question Arashi. Talking from experience regarding previous ht's, everything you see in donor, in 3-8 weeks time line, are regrown transacted hairs, and maybe hairs in resting phase(telogen), that got a boost from acell/prp.

07-20-2014, 06:28 PM
Dr. Cole, could we get an update on your regeneration studies? how are things coming along with Aminofix? Could see the pictures of your recent study?

07-21-2014, 01:16 PM
Dr. Cole, could we get an update on your regeneration studies? how are things coming along with Aminofix? Could see the pictures of your recent study?

Dr. Cole will return to the office on Wednesday. I will ask him for more details. The short version is:

On 06-04-2014, our first patient had AmnioFix administered after his surgery. He's a local and should be able to return soon for evaluation. On paper AmnioFix looks better than ACell and PRP. Since our first patient, three others have had AmnioFix applied to their donor extraction sites.

Dr. Cole will examine our patient's donor areas under magnification for hairs growing out of extraction sites. Amniofix is expensive, so the results will need to be a significant step up from our ACell study results to justify its continued use.

Overview (http://www.mimedx.com/products):
"Amniotic membrane is a unique material and its composition contains collagen types I, III, IV, V, and VII. Amniotic membrane is composed of structural extracellular matrix (ECM), that also contains specialized proteins fibronectin, laminins, proteoglycans and glycosaminoglycans. In addition, amniotic membrane contains essential, active, healing growth factors such as epidermal growth factor (EGF), transforming growth factor beta (TGF-b), fibroblast growth factor (FGF), and platelet derived growth factor (PDGF).8 Amniotic tissues have shown little to no HLA-A, B, C antigens and β2 microglobulin.3"

07-21-2014, 02:18 PM
Could you email me, or post the results from your last ACell study? I may be interested in doing my next FUE with Dr. Cole if he's getting fairly consistent regeneration..

07-22-2014, 07:10 AM
Could you email me, or post the results from your last ACell study? I may be interested in doing my next FUE with Dr. Cole if he's getting fairly consistent regeneration..

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