What One Patient Did After It Was Done

[Jotronic]

The images below show a patient that was in our office today. He previously underwent a procedure for roughly 2000 FUE grafts with the idea that it was a scarless (or at least no visible scars) procedure and that he would be able to wear very short hair styles with no evidence of surgery. At worst he could expect "hypo-pigmentation" or in layman's terms an absence of pigment.

FUE is supposed to also be more economical than strip. The argument is centered on the option of being able to "cherry pick" larger grafts so that more coverage is achieved with fewer overall grafts thus lowering the final cost when calculated on a cost per graft system. We find this to not be the case as part of this calculation assumes consistent growth. We find many cases of FUE where overall growth has been disappointing at best. Below is one case where we believe no more than 25% of the grafts placed actually grew in. Note the large spaces between the grafts in the frontal hairline.




What is "hypo-pigmentation" though? Simply an absence of pigment? Scar tissue has no pigment either so it seems logical that the two terms may be more synonymous than previously thought. Regardless this patient can no longer wear the short hair style he prefers because of these spots with zero pigment, better known as scarring.











Hair transplantation is a surgical procedure no matter how you look at it. Be it strip or FUE your skin is being cut with one and only one goal in mind. To get to the good hair that you need so you can place it on top with the idea that you will be less bald and it will look natural. Period. Your main objectives should be excellent growth and naturalness. The understood trade off is that for the benefit of having more natural hair where you need it you will have, somewhere, evidence that surgery has been performed but if that evidence outweighs the benefit as shown above then the question becomes one of whether or not FUE truly is more "economical".

[Laserhead]

This guy must be very disappointed. I would be devastated if I spent the time and money to have hair transplant and that was the result. How many of the grafts took, like 200? The dots on the back of his head must drive him crazy, especially if he expected to be able to shave his hair short without any visible scaring. The area still looks red, is this normal? Was this FUE, or FUE2? What happens now, can he be fixed?

[Zao]

This guy must be very disappointed. I would be devastated if I spent the time and money to have hair transplant and that was the result. How many of the grafts took, like 200? The dots on the back of his head must drive him crazy, especially if he expected to be able to shave his hair short without any visible scaring. The area still looks red, is this normal? Was this FUE, or FUE2? What happens now, can he be fixed?

This certainly proves that FUE causes scars. I wonder what this guy's head would like like after 4000 grafts? If you need to grow your hair to cover these scars, what is the point of spending more money and time in the operating room since you can't really shave your head too close anyway? Might as well go with the proven method and save time an money.

[Jotronic]

Laserhead,

When I refer to FUE I am referring to it generically with no indication of the particular variant on the technique. Dr. Hasson estimated about 500 grafts took. The redness is something that appears to be normal for a lot of FUE patients that we've seen. The problem that causes this is usually from a graft that was transplanted but instead of growing eventually it causes an immune response where the tissue tries to reject the hair, or what is left of the hair. This can cause additional scarring as well. Most patients that do not have growth issues do not have redness like this.

Zao,

"If you need to grow your hair to cover these scars, what is the point of spending more money and time in the operating room since you can't really shave your head too close anyway? Might as well go with the proven method and save time an money."

Well said.

[Jeffrey Epstein, MD]

It is refreshing to see an unbiased look at what are some of the potential downsides of FUE grafting.
This technique, as I am using it more and more, seems to have some particular indications, but clearly, in this patient, as in most patients, it is unrealistic to expect anywhere near sufficient density in such a large area to be filled in with FUE grafts, and this patient should have been told that he could only achieve a good result with strip grafts. Plus, in this case, it does appear that the size holes were made with a 1.0 or even larger punch, while state of the art is the use of a 0.8 mm punch for less (not that I don't say "no") scarring.
For most patients, because of the typically lower percentage rate of growth and the limited numbers of grafts that can honestly be harvested by FUE in a single procedure (in my practice, this typically is 900 grafts or so with me and my experienced team of assistants), while over a two day period it is possible to harvest 1600 or so grafts.

Jeffrey Epstein, MD, FACS
Miami and NYC

https://www.foundhair.com

[Laserhead]

It is refreshing to see an unbiased look at what are some of the potential downsides of FUE grafting.
This technique, as I am using it more and more, seems to have some particular indications, but clearly, in this patient, as in most patients, it is unrealistic to expect anywhere near sufficient density in such a large area to be filled in with FUE grafts, and this patient should have been told that he could only achieve a good result with strip grafts. Plus, in this case, it does appear that the size holes were made with a 1.0 or even larger punch, while state of the art is the use of a 0.8 mm punch for less (not that I don't say "no") scarring.
For most patients, because of the typically lower percentage rate of growth and the limited numbers of grafts that can honestly be harvested by FUE in a single procedure (in my practice, this typically is 900 grafts or so with me and my experienced team of assistants), while over a two day period it is possible to harvest 1600 or so grafts.

Jeffrey Epstein, MD, FACS
Miami and NYC
www.foundhair.com

Hello Dr. Epstein,
So in your estimation if you want the most hair on top of your head, which is what most men want I would assume when having a hair transplant, then strip surgery is the way to go? If there is a greater risk that your grafts won’t grow with FUE then what’s the point in taking the risk?

[Lex]

JOTRONIC

I want to ask you what happened to this patient? What solution did he end up choosing?

Since I am in a similar position as him I want to know what could be done.

Thank you

[topcat]

From my own experience I have had zero scarring on my head, chest and face from fue. But then again this was a highly skilled surgeon using very small punches. This patient obviously did not do the proper research as knowing the size of the punches being used is critical in the decision making process.

I purposely even trimmed the sides with no guard and took pictures 3 weeks after my procedure to show no white dot scarring.

I could probably show thousands of photos of strip where the patient was left would huge hideous scarring. Does this represent the best clinics out there doing strip, probably not so I would never present such a posting.

This case at best represents doing the proper research when choosing fue and not ending up going to some a-hole that only knows how to sell and market.

"unbiased look" you can't possibly be serious.

[Lex]

TOP CAT

Well I did tons of research before doing my procedure and chose one of the so called "top docs" with a almost perfect reputation. Still I ended up butched similar to the person shown on the pic.

Appearance can be deceptive and what looks like a highly professional doctor based on facts presented on the web can be the complete opposite. This certain doctor knew that I wanted to be able to shave in the future, even so he did not have any inhibitions to basically not give a shit and leave me with terrible scars from using to wide tools.

[topcat]

Lex, I’m sorry to hear about your experience.

Top docs based on what is posted or marketed on the internet is a load of crap. You have to meet patients in person and speak with them on the phone. Have as many consultations as possible and ask as many questions of the clinic as possible. If the doctor or clinic is put off by this than move on it’s a red flag. Speak with employees of the clinics and ex-employees if possible. Read the forums for a minimum of I would say 5 years. Reason being is that most of the disgruntled patients of these top docs have their posts deleted. Speak to as many long time posters as possible, meaning a poster that has been around at least 5 years and has seen all the bullshit that goes on. I'm sure if you would have consulted at least 5-6 long time posters you might not have chosen your particular clinic.

I almost went to one of the top docs that is well known for his shot gun blast donor scarring. But I spoke to enough patients to realize that he didn’t seem to mind using a larger punch because it was easier without mentioning it to his patients. He also happened to have a very poor attitude which was already a red flag in my book. In fact I almost went to many of the top docs because I was desperate to seek out a repair, but I waited about 12 years before making the commitment.

This message is not directed to you but to others that are researching. I hope you find a solution to your current situation but it is a difficult problem to solve at this point other then just growing your hair longer.

[topcat]

Lex, the majority of patients are not going to come to the forums and post about their bad experience and especially name the clinic or doctor. But if one is around long enough you are able to make contact with dozens and dozens of patients who are more than happy to tell you more about their experience in person or on the phone along with naming the doctor and clinic.

The few that do post to the forums often get attacked and it’s not work their time.