Artas

[Denverguy]

Many thanks, best of luck to You as well. I believe then it must take 1k grafts for significant difference in the front or in the back .. to give at least somewhat decent covering to bald spots.

What stage on Norwood were You before all procedures btw ? Also do You take any drugs to maintain Your DHT non-resistant hairs ? I hope those haven't started to fall out in time.

Hey there, I was a 3V, I don't need to use any topical or prescription meds anymore, i use to use Proscar but I have not lost any more hair.

[StressedToTheBald]

Ok, I'm probably 1 stage worse. Encouraging stuff is that You don't have to use minox and propecia any more. I try to avoid them at all cost. I know surgeons tend to prescribe these after the procedure - but I think some people suggest these should be taken for life anyway - as hair transplant might be compromised if old hair, the one thats not transplanted, if the thininng continues with those old hairs - then the hair density of the transplant can be put in danger.

[John P. Cole, MD]

Optimal standard of care

The optimal standard of care for FUE today is a follicle injury (transection rate) under 3% and over 2.9 hairs per graft.

The robot has a mean follicle transection rate of 8% and averages only 2.4 hairs per graft. In other words, the robot is significantly below the optimal standard of care for FUE today. Other methods of FUE including manual and mechanical methods have superior results. While the robot method of FUE has very few results, there are many thousands of results from FUE by other means.

The robot is useful for patients who desire a FUE procedure from a physician who cannot provide FUE by more optimal means. Generally, this means the physician lacks the hand eye coordination to perform optimal FUE, the equipment to meet optimal standards, and the training to achieve such a standard. For many physicians the robot is beneficial simply because the physician does not want to invest the time or energy to learn and perform optimal FUE.

The robot in its present form cannot match the skill of a top FUE physician. The robot will not be able to produce hair transplant results that match the most skilled FUE physicians. Patients who desire the optimal results from FUE should seek a solution other than the robot.

One thing I’ve learned in over 20 years of hair transplant experience is that patients tend to get excited about new technology. The robot is one technology that has a long way to go before it can match the optimal standard of care with regard to FUE.

[Dr. Glenn Charles]

That's awesome. Dr. Harris does do some really fine work.

[John P. Cole, MD]

Agreed, Dr. Charles, but the issue is robot vs man. In a delicate cosmetic surgery procedure we cannot compare John Henry to the steam driven hammer. The question with any computer based automated surgical system is accuracy, intuition, sensitivity, and results.

Just a few years ago, robots did not have the sub-1mm accuracy to do an FUE procedure. They are much closer today, but is close good enough when every follicle might count in someone with advanced degrees of hair loss? The one salient feature all surgical robots share is visualization through the use of cameras. Cameras are nice to have when you are backing out of a parking spot, but would you drive with one? Robots add a second camera to give perspective, but are these as good as a set of God given eyes? NO! Visualization is the primary limiting factor with any Robot surgical system with regard to accuracy. How does this limit the robot in performing FUE? When more than one hair exit the scalp from a single follicular unit, the robot has a very difficult time determining hair growth direction unless all the follicles are lined up identically coming from the same follicular canal. Of course we know from Headington that follilces in follicular units often exit from more than one follicular canal. While follicle does it line up on? What if they are going in slightly different directions? The robot does not have the intuition to account for this variation. Because the robot has difficulty making these direction determinations with more complex follicular units, the robot tends to skip over follicular units with follicles exiting from different follicular canals. With this system, the physician has the capacity to override the robot, but not unless he is actually sitting in front of the computer. If the physician is standing 3 feet from the patient with his back to the entire process, the physician is not in charge of anything the robot does and the physician is turning all surgical decisions over to an unlicensed entity (robot or technician). What happens when the robot skips the more complicated follicular units? The robot harvests grafts containing fewer hair in each graft. This is why the robot averages only 2.4 hairs per graft despite using a 1.2 mm punch. Now the physician could sit behind the monitor and control the robots decisions. This would help increase the total number of hairs per graft, but the follicle transection rate would still be high and the procedure would slow down significantly. Remember that hair restorations surgery physicians are often quite lazy. They like procedures where someone other than the physician does most of the work. Thus not only would the graft harvesting slow down, but the physician would actually be forced to sit and control the decisions that the robot makes. Remember that physicians like strip procedures because the technicians cut the grafts. The beauty of the robot is that the robot cuts the grafts. Thus, don’t be surprised if your physician is not sitting behind the monitor and controlling the robot during your surgery. However, if he is not sitting there and I were the patient, I would insist that he do my surgery rather than a technician or a robot that lacks intuition.

Suppose you have one procedure where the robot takes the “easy grafts”. What happens in the second and third procedure where you now need to take the more complex grafts? Higher follicle transections and a poorer yield are the likely outcomes. The truth is that no one knows, because the product came market without dealing with that outcome. If I had been the chief clinical investigator with this product, it would not have been marketed to other physicians until we had evaluated a number of potential clinical outcomes and designed solutions for them. That would have required at least one to three more years of evaluation.

What about feel or sensitivity? Every patient’s skin is slightly different. Skin can change from one region of the scalp to another. Skin can change when moving from low to high in the donor area. If the skin changes, the way you harvest the grafts will change. The diameter of follicles and the number of follicles in a follicular unit change as you move laterally in a donor area or superiorly in a donor area. In harvesting, you need to make alterations in how you harvest to accommodate for these changes. Robots have no capacity to make alterations due to either variable. What about when you are about to cut a follicle. When I cut grafts manually, I can feel it when I am about to cut a follicle and when I do cut a follicle. I can make changes in what I’m doing to account for this. Robots have the sensitivity to tell the difference between cutting bone (your skull) and skin. It is less well known if they have the sensitivity to detect minor spikes in force comparisons between follicle and skin.

There are two forces involved in cutting a follicle with FUE. One is an axial force and the other is a tangential force. This particular robot uses a punch that cuts skin, but it is not very sharp. In order to overcome the strength of the skin and break the skin, a punch that is not very sharp requires more of both forces. The two forces act quickly if you look at the videos. There is very little time for sensitivity evaluation and change based on minor changes in tissue type. Also, the higher axial force results in more follicle deflection. The follicle deflection moves the follicle outside the lumen of the punch and results in a much higher follicle transection rate.

The popularity of FUE is on the rise today. Patients are more and more aware of the potential benefits of FUE over a strip-based procedures. The popularity of FUE results primarily from physicians who have been doing large numbers of FUE cases for many years. A robot will help make the option for FUE much greater for many patients. An 8% follicle transection rate with the robot is not terrible. In comparison it is very good compared to many physicians. An average of 2.4 hairs per graft is better than many physician, as well. The real question is what is the optimal potential result with FUE? The optimal FUE result is much better than the robot can deliver.

The top physicians who perform FUE have thousands of results. They do not and they have never used a robot to achieve these results. Personally, I developed 4 automated FUE devices that could not match my manual results so I never used them and never offered them to other physicians. Then I made one that was very good and comparable to my manual results. For me, however, the question of using this robot in it’s present form does not exist. I would never accept the marginal results that it can produce. For me, only the most optimal results are acceptable. For me to achieve these results, I need far more variables because all patients are different. I need the option to make changes quite simply because often times changes are essential. I’ll give you an example. This week, Dr. William Reed visited my office. When I first started the case, my follicle transection rate was 6.9%. I made two quick changes and the follicle transection rate dropped to zero percent. Those two changes in variables are not even possible with the robot and I’m betting the follicle transection rate with the robot on this patient would have been 12 to 15%. Now in a 2000 graft case where you can drop the follicle transection rate to zero percent, you will still have some follicle transections, but they are not high and certainly nothing similar to the robot. In my 2000 graft case, I averaged 2.96 hairs per graft. The robot would have averaged no more than 2.4 hairs per graft meaning that of the 4800 hairs harvested more than 480 would have been damaged. In my case we harvested 5920 hairs and almost none were damaged. In other words, my equipment produced over 1500 (nearly 1600) intact, undamaged follicles more than the robot could have produced.

If my personal goals were simply to provide surgery with less personal effort, then I could accept using a the robot in it’s present form. Unfortunately, my personal goals and expectations have always been much higher. I could never accept the mediocre results that a robot can produce. I’ve been that way since I began doing hair transplant surgery. For me, I could never sit back idly while my surgery staff cut and placed the grafts. I had to be involved and I had to make sure they were doing great work. Only when I was certain they were doing great work, could I delegate the work to them. Think about it. How many physicians have as many really talented physicians working in other clinics throughout the world that got their start as a surgery technician for me. They include Drs. Bisanga, Mwamba, Bridges, Devroye, and Michalis. There work today is outstanding because they all have the desire to produce excellent results. However, they would not have gotten the chance to learn their trade and skills had I not placed such emphasis on quality and expectations. I placed great expectations on each. Had they not delivered, I would have terminated them. The robot does no deliver in my opinion. While it is a great option for many physicians and their patients, it would not have made the cut with me. I would have fired it long ago.

This leads us into one final thought. The IAHRS is supposed to be a collection of physicians who do the very best work. As far as FUE goes, the robot does not belong on that list. I agree with Dr. Harris that the robot gives many physicians the opportunity to deliver similar results out of the box. The problem for me is that those results are mediocre. The robot results do not meet optimal FUE results. Now, I heard some physicians who said they were going to buy the robot at the meeting in Alaska. Most of them were buying it for two reasons. One was for marketing purposes to consumers who get excited whenever there is something new. The other was because the robot could do the FUE procedure better than the physician could currently do with the equipment he owned. It seemed funny to me that a physician offered FUE to his patients even though he could not beat an 8% transection rate. I would have asked for training from someone like me or stuck with my strip procedures, but again I can’t accept mediocre.

What about individual physician talent? Very few physicians can actually place their own grafts. Even fewer have ever cut their grafts. Most physicians rely on the skills of their surgery team to do the procedure. Over 20 years in hair transplant sugery has taught me two things. Both surgery technician and physician abilities vary substantially. In my opinion, it takes more talent to successfully harvest FUE grafts than it does to cut a strip or make recipient sites. If you don’t have the hand eye coordination, you should use the robot. Simply buying some tools will not make you good at FUE. You need to know how to use them. You need to have the desire to learn it. You need to have the drive to put in the time to cultivate the skills. You need to believe in the results. Some catch on in one day. I’ve always felt that I can teach anyone who has the hand eye coordination to do FUE in one week of hands on training. One took longer than one week, but he turned out great. Still I know of two that I would not allow to ever touch one of my patients and I suggested they both take a desk job. If you can’t catch on and you want to offer FUE, the robot is a good option.

Then what about the physician who uses an unlicensed surgery technician to harvest their grafts? I say the term surgery technician loosely because there is no governing body that gives a degree or title of hair transplant surgery tech or assistant. Many techs have no formal training at all other than what they got when hired by a hair transplant doctor. Many of these physicians may be breaking the law in their state. State laws vary. If it is against the law for a layman to do surgery on a physician’s patients even when the physician is in the office, then the robot might be an option for those physicians. Then again, how legal is it for an unlicensed individual to sit behind a computer and monitor the surgery or change variables while the physician is not in the room or has his back to the surgery, i.e. talks to a video camera while the robot cuts away on the back of his patient’s scalp. In that the person behind the computer can alter one or two robot variables, perhaps there are issues in some states. I don’t know. However, I’m sure it is far better to have an unlicensed individual watching a computer screen than to have an unlicensed individual with no formal surgical training cutting FUE grafts out of the back of a persons head. In such clinics, the robot makes sense and is perhaps cheaper than what freelance surgery techs charge to go into an office and perform the entire procedure for a physician who has no idea how to perform a hair transplant.

Regardless, the robot is no IAHRS material. You are doing patients a disservice when you promote it in a forum dedicated to the highest quality of results.

[StressedToTheBald]

I can see Your point Dr Cole.
Question in reality is.. how many surgeons have the ability or even will to indeed outperform this new robot. And it surprises me the fact, that although a fortune of thousands and thousands of dollars is required for a high-end surgeon and a full transplant, when it comes down to procedure itself, the huge amount of work regardless of the technology is not done by the surgeon, but medical technicians. If we aspire for such an expensive procedure, the least we should get for our money is the very best of skill, fine precision and dedication - more involvement by the surgeon or even a team of surgeons, not technicians. Even more when technology is not involved. I still fail to understand why the procedures are so expensive.. other cosmetic surgeries, even ones that require material in the process fall way behind in price terms comparing to hair transplant.

[John P. Cole, MD]

You make some valid points. Honestly, i don't think there really is anything difficult about doing a hair transplant, but then it is all second nature to me now. When you'v put in over 10,000 hours practicing a skill set, you become an expert and very, very good at it. Still, I've seen some physicians who I would not want to continue doing hair transplant surgery after attempting to train them. As simple as it seems to me, some can't do it.

I also get your request to have more physician involvement. It's funny that when i began doing FUE, I continued to send out patient evaluation forms. What i found was that patients began feeling that i was spending less time in the surgery room than they expected. The primary difference at the time was that i switched from spending more time placing grafts in front of the patient to spending even more time behind the patient trying to remove grafts. Patients could no longer see me so they began to feel that i was spending less time in the surgery room. I think it's a real problem for many patients regarding physician time with the patient. i recall one patient who came to me to complain about his FUE results done by another physician. The patient told me that two girls harvested his grafts and they harvested them from areas in front of his ears such that it made the areas thin. He had asked the physician why he was not doing the harvesting and who were these two girls who looked like they were in their early 20s. The physician replied that the girls were certainly capable of doing the work and that the physician did not have the time to harvest grafts and mind the rest of his practice at the same time. Needless to say, this created ill will.

I also hear you regarding pricing. I think you are seeing pricing competition in strip surgery. You'll see it in FUE too. The simple truth is that FUE can really wear a physician out if he's in there doing the job every day. the advantage to a robot is that it does not wear out.

ok, the most follicular units you can get from any donor area is between 3500 and 8000 with the average between 4500 and 7000. Now some physicians take out 2000 follicular units, but turn them into 3000 grafts by splitting up follicular units into ones and twos. At any rate, you maximum scalp hair by the follicular unit should be multiplied by 4500 to 7000 typically.

the best thing to do if you are concerned about pricing is to discuss it with your physician. ask him for a break. you might find that he will help you out in that regard. My philosophy has always been that there are patients who need a financial break. That's one of the characteristics about the wonderful health care system here in the USA. I know many physicians who share the same feelings so when in need don't be afraid to ask. I once had a patient show up at my office from Europe with no money, no place to stay, and in need of hair. He wound up staying in my home for 2 years before going home with hair. It's an interesting world. Don't be afraid to spread your wings and explore your options. Just don't be foolish and enter into a procedure that is not right for you. The fact is that good candidates for hair restoration make physicians look good. If you are not a good candidate and you have maximal hair loss, there is no magic that can over come it. If you are not a good candidate, a good price is not necessarily in your best interest.

if you are over a NW class 3V and you want maximal coverage, you better have a hair check over 75, maximal follicular density, and a larger hair diameter. Otherwise, you are going to be disappointed.

[StressedToTheBald]

As with everything one has to be an expert and do the best in the field of work. In real life sadly thats not the case and way too many doctors give medicine a bad name - either by poor work or by putting profits before the patient. I always recall my own personal example, although not hair related it was surgery & technology related.. When I was younger I had serious acne issues, spent months on Accutane.. and somewhere along the way I went to a private practise and a surgeon who advertised for laser removal of the scars. I was young, and laser I thought.. well thats brilliant, like in the movies ! I couldn't afford the price of the laser procedure for my entire face - so I asked the surgeon to only do spots, partial areas. He never truly explained me that this laser tech was cutting like a knife, harsh and might leave even worse scars than I previously had. I should have known better ! And as a sign, the first time I was on the table - the laser turned out to be broken.. So I came for the 2nd time, got local anesthetics, and was done by the laser. Badly done ! I went home with severe cuts and round holes on my face, it took so much time to heal and surprise - I ended up with worse scars than I came with. The surgeon who did it never even scheduled me for a check up.. He gave me a discount as the laser was broken and had to come for the 2nd time, and when I asked him via e-mail, worried about slow healing and everything.. he was very rude and barely responded. I felt so down and betrayed, it wasn't expensive, but it turned out to be one of the most expensive mistakes in my life.

I hear You about the time with patients. Well, its important, it feels like we're taken care of and get the attention we deserve. Also regarding FUE, You said it takes more time.. I thought so, I think it takes much more skill too ! Further more I believe its one of the reasons why so many surgeons still put FUT as No.1 - because its easier to do, and also probably because most surgeons started their practise in other areas, where stripping comes as more similar, traditional thing. I myself would never go with FUT, I am prone to scarring and wouldn't like a scar on the back of my head. On the other hand FUE is much more expensive and most likely tougher to perform on higher Norwood cases.. I'm roughly 4.. maybe 5 on Norwood, with expressed receding hairlines and balding crown.

At this point I cannot afford a transplant. I live in Europe.. but its the poorest country in Europe, and to be honest money always was and still is a huge issue. Even though the surgery if much cheaper here.. I for one would never do it here.. I'd do it in USA, UK or Ireland, all still wishful thinking at this point in time. Doing this type of surgery only partially - 1,000 or so grafts wouldn't solve my problem and also doing it by a 3rd world surgeon - even if its cheap - could turn into a very expensive mistake.

So, now I'm waiting, doing research. I wouldn't dare to risk the side effects of finasteride, so I went with the best DHT blocking alternative and am in my first month of 510mg beta sitosterol + 300mg of saw palmetto. It would help a lot even if I could fall down 1 scale on the Norwood. I can notice some tiny colourless hairs under my receding hairline, but I need much more than that, only full set of hair makes sense at the end of the day, and without transplant that sadly doesn't come over night.

[John P. Cole, MD]

Difficult situation for you with many obstacles. As you've noted sometimes obstacles are a good thing including broken equipment. One should never rush into cosmetic surgery or many other things in life, but especially cosmetic surgery.

What you have to always consider is what sort of candidate are you? You must have good donor area. You must have an acceptable degree of hair loss that can be resolved both short and long term with your donor area capacity. I've always said that it is the patient that makes a good physician look great. If you have poor characteristics, then you are not going to be the optimal candidate and you might be better off doing nothing. What about future hair loss and age? Success today can be a failure tomorrow if you don't consider all this.

I do a lot of pre-operative measurements on my patients. i take 14 donor area density measurements, scalp compression, scalp extension, present and anticipated scalp hair loss surface area, hair diameter, cross sectional trichometry in the frontal scalp, mid-scalp, crown, and vertex, along with donor area photography. i do my best to evaluate patient candidacy prior to surgery. If you are not a good candidate for what you want, then i try very hard to dissuade you from surgery. Also, proper evaluation allows the physician to plan a long term treatment goal including an exit plan for surgery. Hair transplant surgery is like a train ride to the top of the mountain. The patient wants to reach the top, but mother nature keeps pushing the patient down the mountain. You always need an exit strategy should the patient goals be unattainable for a variety of reasons.

Another thing to consider is short and long term costs. I'd be happy to do your work for what ever you budget is, but is this the right thing for you? Suppose you get started and then need more as you loose more. One has to be careful getting started on a hair transplant process because hair loss changes over time and goals also change. Many in their 30s today wish they'd never started hair transplants in their 20s. i'd say these guys make up at least 30% of my repair cases.

Yes, your laser experience sounds awful. I don't think it matters who seems to cheat us in life; it never feels good. But....having a physician, a caring, empathetic person do it to anyone can be demoralizing. It breaks my hear to hear stories like that. it's very disturbing. Back in 2002 there were so many patients complaint about their strip scars. It was surprising to me because I'd done over 8000 strip procedures at the time and could think of only one patient who was emotionally distraught over his strip procedure. The worst strip scar i ever produced was 0.5 cm wide so i guess i must have been pretty good at them, but my average was still 0.3 mm. Some were so good that you had trouble finding them. Once i began offering FUE back in 2002 and 2003, i really found out how many patients were upset about their strip procedures. Suddenly I was doing over 40 FUE cases each month and I had to get good at them fast. What i found was that FUE offered a better aesthetic option for patients. It is not to say that my personal strips were not pretty good. You just could not predict a strip scar. Some were very thin and some were wider. Thin scars often become wider with a second or third procedures. So....even if you dodge the bullet the first surgery, you might get nailed the second. If you are prone to wider scars, you might find the same with the strip. Strip surgeons sometimes are skilled at making scars wider for some reason. Should you find yourself with a scar over 1 cm in width for no apparent reason, you will understand how disfiguring this can be and fully understand the capacity of your surgeon to create a wide strip scar. He's gifted in a bad way. While i had only one patient complain about his strip procedure before i offered FUE, i did have a few more come back specifically to treat their strip scars. Even a few of my patients had moved on in life and simply wanted to go bald gracefully.

I'm headed to Cyprus next week. I'm helping to open a clinic in London soon so I'm going to be working with the staff. If you find yourself in the neighborhood, I'd be happy to take a look at you.

What do you think of the laser cap? I'm just curious. I'm not sold on it.

[StressedToTheBald]

Way too many obstacles where I am, life is unfair here. That broken laser during my 1st visit too.. it was like a red sign saying 'don't do it, stay away', I shouldn't have come for the 2nd time. I agree 100%. Cosmetic surgery is something one shouldn't jump into without thinking, I was much younger back then, wasn't thinking and I had way too much blind faith both in people and technology. Learned my lesson the hard way.

I'd like to know that as well, what candidate if any I might be. Haven't got a clue if I am a good candidate or not. I mean - I have plenty of hair sideways, but if I got it right not all of it can be used as a donor hair. Its a good question about the future prospects too. I tend to think my baldness hasn't gone down the road, it feels I have what I had a few years ago. I'm round 30 now, but when I think of it - I was fairly bald since teen age.. I never had a healthy strong frontal hairline. In my 20s, I was on very high doses of Accutane - for 6 or 7 months - only now I read how powerful this drug is, and if nothing this drug alone could have boosted my baldness before time. And its very fair to say that if a candidate is not good, one shouldn't start the walk one cannot end. My respect for Your views doctor, in a world we live in, few people actually have the ethics to always keep the professional approach.

I need to save up some real money for the transplant. Serious money. Its complicated to explain my situation here, but I live day by day, and my monthly budget comes to few hundred dollars which at the end of the day is pathetic comparing to Western standards. Tough luck beeing born in one of the poorest 3rd world countries, although in Europe, I'm not in EU and beeing a non-EU citizen I am a 2nd class citizen. I always wanted to move out, but I am still bound here, tough luck, also been applying for US green card.. this is my 3rd year, chances to get it are 1:100, still I have to have some sort of hope that my luck might change this year. Either that or maybe central Europe - I might get a job in central Europe, although I dislike it, my official degree is in International Business, BIB.

Its good news, the clinic in London. I'm far off but I'd like us to stay in touch, maybe at some point a consultation would be in order, to see where I stand at least.

There seem to be several type of these laser devices, comb, hat, that large cupole thing also. Can't say I wouldn't give all of them a try but not sure I would put too much faith or money either way. This reminded me - I also had personal experience with soft lasers for my skin in the past.. I can't say soft lasers did anything for me back then, I probably spent few hundred dollars on multiple treatments, and while on a bed with red laser lights and music feels relaxing and maybe closest I've felt to meditation, results wise I'm not sure if lasers can treat skin or hair conditions.. Even when I went to my surgical procedure - at first I thought it was some sort of light beam - like with soft lasers, but it turned out to be completely different laser type, hard laser, ablative or something I think. What puzzles me also, and asked here on the forum too, but no one knew the answer is the comparison between infrared vs. laser.. Laser has a different spectrum in nanometers.. if this spectrum is crucial as stimulator, then infra red as substitute might not have the same effect. Just a thought anyway.

[StressedToTheBald]

Yes, but the big if is - if these lasers work via production or stimulating energy in the cells.. can this actually boost the regrowth of DHT non-resistant hairs, even ones worst affected, which have shrinked to the point of bare visibility. Are there clinical studies showcasing high success rate in terms of regrowth in the bald spots..

I agree that these laser devices are overpriced.. That laser comb alone is 500$+.. the production value itself is as You said must be just a fraction of the cost. And if it worked for sure then it would be well worth every penny of the retail price, but I'm just not convinced. I found that at some places infrared light is mentioned as beneficial, the cost of infrared devices with built in massage starts as low as 20 or 30$.. but then again, the light spectrum is completely different and if thats what makes the lasers work, then a wrong light spectrum and infrared would be completely useless.

Back to the energy production. I've read that nitric oxide can play a crucial role in the sense of boosting energy and blood flow in the folicles. One of the best examples in that sense, amino acid called arginine is marked as very potent nitric oxide booster. I myself am currently using 3,000mg of arginine daily via protein shakes. What is Your stance on nitric oxide and its potential to bring the energy from within ?

Excellent comparison ! When I imagine FUE vs. FUT, although I'm not an expert, the first thing that comes to my mind is no scar vs. huge square scar on the back of one's head. In that sense it must be mm vs. cm, and the very precision and skill needed, comparing these two procedures, it feels like FUT belongs to 20th century and FUE is the 21st century procedure. As for those lasers that burn skin.. the worst thing in the world, I'm the proof, a surgical knife wouldn't make less uncontrolled damage.

Thank You. English is my language.. long story of my rather unique life..
Emigration is a nightmare, I know and know it first hand, it used to be much easier in the past, maybe 10 or 20 years ago, but these days its next to impossible. Unlike EU, every year US government gives away 50,000 free green cards to imigrants worldwide, so each year I apply, its like winning a lottery as beeing selected would open to the doors for the permanent residency, but as I said chances are like 1:100. If I would be able to move West, I'd be one step closer, most importantly it would be a step into freedom, but also achieving the solutions to my problems - hair unfortunately is just one of them. What I do in life has a lot to do with selfconfidence and selfimage.. as much as baldness is not portrayed as a medical condition in the true sense of the word, it very much feels like one every single time I see myself in the mirror.

[Tracy C]

Are there clinical studies showcasing high success rate in terms of regrowth in the bald spots...

Nothing that is currently available works to regrow hair in areas that are void of hair and have been that way for a long time (five years or more). Not LLLT, not Finasteride, Not Minoxidil not Bimatoprost, nothing…

The documentation on the clinical studies Lexington submitted to obtain FDA clearance is readily available and easy to find. You can't find them? I think that is a little ironic.

[StressedToTheBald]

I agree Dr Cole. I have put a lot of efforts in researching ingredients and compounds - either as supplements or via nutrition that should have an impact on hair regrowth, either by blocking DHT(beta sitosterol, saw palmetto, ganoderma lucidum etc.) or by increasing energy and blood flow, like arginine. Although all these have studies to back their effectiveness, they are not really popular with majority of doctors nor general population who sadly consider propecia to be the only proven internal solution, even though it carries the potential of serious side effects and I believe is not as miraculous as portrayed.

Personally, I am a vegan, therefore my diet includes no meat, milk or any other animal derived ingredient. My major source of protein is soy, whole grains and nuts. I also use plenty of supplements, vitamins, minerals, protein shakes. My current choice for protein shake is a product called Soy Pro - by SciTec Nutrition, USA, and it contains : 1538mg of arginine & 263mg of cysteine per serving. I take at least two of these daily, so my overal intake comes down to 3 grams of arginine and 500mg of cysteine. I'm not sure if this is enough.. its hard to know.. Its also hard to know strength wise how 500+ mg of beta sitosterol & 300mg of saw palmetto which I also take daily.. how these compare to 1mg of propecia.

You mentioned treating grafted areas with arginine, ATP and other antioxidants.. are any of these available in liquid form and are they beeing sold somewhere ? The best I have came up in that direction is finding a German brand of shampoo which contains arginine.

All the folicles indeed exist and never die.. even with those people who have entirely bald scalps. Latest research shows that clearly, but even though the folicles are there, they have become so miniaturized that they're pretty much invisible. The problem of how to awake them is the crucial one - if someone would find a clear straightforward answer to this question, it would be a revolutionary discovery, the cure. Sounds simple enough, yet even doctors who are involved in ongoing researches often claim that cure might be decades away.

[StressedToTheBald]

Thank You, I try to do my best, this reminded of a quote I've seen recently of 6-10 years added life prospects with vegan and vegetarians. But to be honest, stress probably takes away what I gain.. I stress a lot where I am and its very hard to combat situational disturbance. I've simply seen too much in my life.. this country has been in wars, poverty, misery, corruption.. still is in so many ways. Anyway, back to the supplements, for stress - I use B100 complex, over 1000mg of Vitamin C (God bless Dr Pauling btw, the father of vitamin C.. he was taking many grams daily and lived a long life; FDA recommendations regarding doses and importance of vitamin C are extremely underestemated, and it may impact not just stress but aging and heart attacks; very interesting fact I've recently learned - animals under stress produce vitamin C on their own - so if they need plenty, their bodies make it happen; we humans cannot do that, thats why it has to be added as a supplement); I also use 5-HTP 100mg - precursor to melatonin. On and off I use melatonin too..

I have found the conclusions of the 2011. Boston study by Dr Traish regarding propecia.. and it points out the correlation between persistant erectile dysfunction and propecia. It says the risks should be clearly explained and other alternatives considered. Even FDA states that however small, the risks are very real. Even if the percentage of side effects is only a few percent, I find it rather surprising that so many people are ready to gamble and put their health at risk.. the potential of hair regrowth for the potential of permanent impotence or other side effects, simply doesn't sound like a fair deal to me, regardless of the chances that the worst most likely won't happen.

Merck has recently added depression to the list of side effects. This reminded me of my own adventure with Accutane drug.. I don't know how much You have heard about this drug, but many people today accuse it for severe depression.. one US senator has even accused this very drug for his son's suicide. I can't say what side effects it has left on me.. I did have a bad time during the treatment, but pushed on till' the end. Do I regret it today ? One thing is sure, although it helped me for one condition(well not 100%, as I on and off had problems since) it might have left a mark in other areas - including the rapid progress of my baldness and also depression wise - it might have left a depression mark as well. I don't have a proof, its obviously hard to measure these things.

Many thanks for the list of ingredients, I appreciate it very much. You mentioned using them on donor areas, places of extraction, but wouldn't their significance be far greater in bald areas where the both the donor hairs are actually implanted and surrounded by remaining DHT non-resistant hairs ?

I haven't heard about the Diamax.. but I have been seeing some studies claiming the benefits of caffeine for activating folicles. I think it all started from a German company, manufacturer of Alpecin. I have been using on and off their lotion and shampoo some time ago, but sadly I cannot say it delivered any results in my case. Still, I have another shampoo brand that does contain caffeine, even today, although I don't put much faith into it. Caffeine related, it is interesting that inositol is reported as potential beneficial ingredient for hair loss - but when we drink coffee, caffeine actually kills inositol in our body. Its an interesting brain teaser for sure. I like coffee, but this and the fact that caffeine spikes cortisol - stress hormone, this more recently keeps me away from a good cup of coffee.

Many of these ingredients I used or am still using right now. How crucial some are and what impact doses are right, that is a much tougher question. I'll try to write some of my thoughts on a few..

Arginine, we talked about. If as a precursor to NO it delivers increased energy or blood flow to folicles, it is a crucial role. I do believe in can play that role, thats why I am using it. Speak of the devil, just ran out of it, need to get out and buy more tomorrow.

Vitamin E. If I recall well, I've recently read that Vitamin E also has a role in production of nitric oxide. Further more, I remember seeing some claims that Vitamin E might be able to block androgen receptors - DHT has androgen receptors in hair folicles. Question however is - how high doses would achieve this - and if used as topical solution, would Vitamin E actually be able to penetrate hair folicles and from there on has some impact on blocking DHT receptors.

Ginko biloba. I have used ginko both topical and in tea form. This herb is well known for boosting periferal circulation. College students even use it for concentration and focus. I'd give it a plus for boosting circulation.

Green tea. Green tea could be one of the most underestemated substances out there. I have found studies, reporting that green tea blocks DHT, plus it is a powerful antioxidant. Very interesting fact however.. concentration. Tea itself contains catethins and other substances.. but it seems that it would take like 7 cups of tea to match 1 tablet of concentrated extract.

Saw palmetto. I use saw palmetto, 300mg daily. Study on androgentic alopecia using saw palmetto + beta sitosterol reports 60% of improvement success rate. Saw palmetto indeed blocks DHT - it is highly praised for treating BPH - enlarged prostate.. same way as dutasteride (5mg finasteride).. I've even bumped into claims that saw palmetto is more powerful than finasteride. I wish there were comparison charts in terms of dosage ! Interesting fact also, some consider that sterols in saw palmetto is what makes it effective and that beta sitosterol - which I also use - is 1,000 or even 3,000 time much more potent than saw palmetto. I put my faith in saw palmetto + beta sitosterol to be the nature's alternative to finasteride, a safe alternative !

Rosemary. I have used rosemary topcial. Now have it in my shampoo. I'd give it a plus - similar to ginko, it is I believe beneficial in stimulating circulation.

Biotin. I've put my faith in it and ended up dissapointed. On and off I gave it a good amount of time, weeks to months.. and I used 10,000 units which is very high, still I can't say it produced any significant results. It might be beneficial to a degree, but its no miracle worker, thats for sure.

Gingseng.. Something I planned to include to my regimen for a long time. Need to get it. I think I had some in shampoo but the point is to use it orally. The only thing that potentially worries me, gingseng is also portrayed as energy booster.. it might be also boosting the testosterone level and therefore more DHT production.

Lavander & Tea Tree Oil. I have recently found hair unrelated study, describing that these have the power to block androgenic receptors. Excellent find. DHT needs receptors in order to bind around folicles ! Shut down receptors and DHT becomes a key without a lock ! I believe I should use these as topical solution.

Grape seed extract. Used it shortly. Would like to include it again. Not cheap, but could be worth it. I believe it has potential !

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Not on the list:

MSM. One that might be missing from the list - MSM. The role of suplhur in hair is reported to be very important. I personally use several grams of MSM as tablets and also use it via 10% balm. Problem with topcial application however might be - if folicles can apsorb MSM via topical solution, some claim that only its other form - so called DMSO can actually be absorbed. I also recall some studies claiming effectivness of garlic or onion juice - these too might be potent hair activators simply due to high content of sulphur.

Procyanidin B-2. Seems to be powerful compound found in green wild apples. Concentration is the issue.. It might take a tone of apples to extract tiny amount of this ingredient. "Procyanidin B-2, extracted from apples, promotes hair growth: a laboratory study. Kamimura A, Takahashi T. http://www.ncbi.nlm.nih.gov/pubmed/11841365"

Sage. Not mentioned in the list, but I believe sage might be very potent herb.. for strength and maybe even in other ways although I don't think anyone gave it anti-DHT properties.

[StressedToTheBald]

An excellent new article on propecia health hazards..
2 top US Universities have made their studies public and for the first time the seriousness of risks is fully exposed.
"Doctors link hair growth drug to sexual dysfunction, depression and cancer"

http://www.examiner.com/courts-in-baltimore/doctors-link-hair-growth-drug-to-sexual-dysfunction-depression-and-cancer#ixzz1mNg2DlhZ