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  1. #11
    IAHRS Recommended Hair Transplant Surgeon Jeffrey Epstein, MD's Avatar
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    I welcome hudson's comments, some of which are quite relevant, provided they are in fact true.
    As a board certified facial plastic surgeon who spent 5 years in a head and neck surgery residency followed by a full year of facial plastic surgery fellowship where I trained under one of the top hair surgeons of all time, Dr. Shelly Kabaker, I can respect the importance of receiving extensive surgical training as a strong background in this aesthetic field. I also know however that in my 16 years of private practice, performing over 500 procedures a year- of which 150 or more are FUE) there are three critical elements to achieiving truly outstanding results that cannot be taught in a several month period of training: an aesthetic eye, experience in hairline design by accounting for facial structure, and passion; and in fact sometimes these cannot be taught at all. My associate, Dr. Glenn Charles, is an example of this. These three elements, all together, are possessed, to varying degrees, by the doctors that Spencer has assembled in his unique recommended list.
    The NeoGraft is a device. It does not assure good surgical outcomes, no more than giving a general surgeon a "bone cutting device" then calling him an orthopedic surgeon, or a vascular surgeon a "heart device" then calling him a cardiac surgeon. Now I understand that a hair transplant is not a cardiac bypass, or for that matter, not even a rhinoplasty (the most challenging of all cosmetic surgery procedures in my opinion), but still, performed unaesthetically (poor angulation of grafts, non-irregular hairline design, inadvertent transection of existing hairs, etc) a hair transplant can have devastating outcomes for the patient, as some of the posts on this site can attest to.
    I do believe that most of the relatively "new" hair transplant doctors being trained in the NeoGraft do not aspire to being a world leader in the hair transplant field, but are hoping to achieve consistent, nice results for their patients. I truly feel that, while there is an economic incentive to adding these procedures (and there better be a financial return to justify the cost of the device), they are seeking to provide their patients with aesthetic results. Here it is the responsibility of the patient to do his/her homework and choose the surgeon who will meet his/her expectations.

    Jeffrey Epstein, MD, FACS
    Miami and NYC
    Last edited by Jeffrey Epstein, MD; 07-03-2010 at 06:11 AM. Reason: left out a sentence
    Jeffrey S. Epstein, MD
    Foundation For Hair Restoration

  2. #12
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    Default Beware of Hair Restoration Doctors not offering the FUE procedure

    After writing my former post, I realized that perhaps the most important warning that the public and potential hair transplant patients need to hear is that the majority of Hair Restorations doctors who do the older Slit procedure, which as I stated is more surgically invasive, painful, prone to more complications, has a much longer and more painful downtime, and produces elongated scars, are not bothering to re-educate themselves and offer the more advanced, patient friendly FUE procedure. Dr. Bauman, himself, and ISHRS member, is puzzled by this as he stated on his live interview with Spencer Kobren. I could understand not offering this procedure prior to there not being a NeoGraft device because the manual FUE procedure had a poor record for high transections and there were other difficulties with a manual FUE procedure. Now with NeoGraft, doctors can do an FUE procedure and experience as good an outcome as with STRIP surgery.

    NeoGraft was demonstrated at the Live Surgery Workshop in Orlando last April, and in numerous live demonstrations done for doctors around the country, who were able to see the results doctors can achieve with NeoGraft. It is difficult to understand why the Hair Restoration doctors are not taking the lead and offering their patients this more advanced, less painful FUE procedure. There has been enough experience with the NeoGraft device to show that the outcome of the hair transplant with the NeoGraft is identical to that with the Strip method, because the principles are the same whether you use the Neograft machine or the Strip method. In the end both methods harvest follicles and implant them into recipient sites, with the exception that follicles harvested with the NeoGraft machine are more identical in size, as they are not cut by hand. As a result they "fit" into the recipient sites, which are the same size as the follicles more easily, lessening any damage from different sized follicles that need to be pushed into the sites with tweezers, a device not used by the NeoGraft machine, which uses a no touch, gentle. no squeeze air pressured tool to implant and extract follicles.

    The idea of Medical Device companies making money by selling devices has been often used to make these companies appear that they do not have the best interests of patients in mind. Perhaps you could explain how it is in the patient's best interest to not offer the patient the FUE procedure which is more beneficial to the patient? At least the patient should have a choice, after hearing all the correct facts as to which procedures are available. Then if the the patient chooses an FUE procedure, let the Strip doctor recommend an FUE doctor to the patient.

    The problem as I see it, is the one I have many times seen with new devices in every specialty. There are always "experienced" doctors who have been trained on an older device who are reluctant to retrain or invest in a new device, regardless if that device improves or advances the procedure and is more beneficial for the patient. We, in the medial device industry, call this group " the old boys club." Why are more experienced doctors often reluctant to accept change? I imagine this happens because they are comfortable with what they do, they will probably earn the same income and when they look at it from their perspective it does not make sense to put in the effort and expense to make any changes.

    To be fair to all doctors however, there is always the possibility that some doctors are confused themselves by the negative, false, conjectures and misconceptions often posted on Forums when new devices are introduced as there was about the NeoGraft device. This prevents some of them from changing to the new method. The same has occurred with many new devices, when they were introduced, that are now used routinely by doctors. However, this does not address the best interests of the patient. It has come to our attention that when patients asked some prospective Strip hair restoration doctors about the FUE procedure, they were dissuaded from doing this procedure, based on the false information that had been dispensed by many of the forums, which was not really the doctors fault, if the doctor trusted the forums. As patients become better informed, we feel certain that they will choose an FUE procedure, with NeoGraft a device that greatly improves the outcome of the FUE procedure.

  3. #13
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    Hudson, with all due respect why not identify yourself to the forum? It’s apparent that you work for NeoGraft and I think it is disingenuous to maintain anonymity if you are working for the company. As patients and posters we depend on having the right to maintain our anonymity, but your arguments might hold more weight if you reveal your identity and credentials.

  4. #14
    IAHRS Recommended Hair Transplant Surgeon Jeffrey Epstein, MD's Avatar
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    Now you have lost credibility hudson, making one eroneous statement after another.
    As a surgeon for whom approximately 25% of my work is in FUE (3 or so FUE procedures a week), having performed several hundred of these procedures, I feel I am quite qualified to correct your eroneous statements.
    The FUE procedure, whether performed by a motorized device or by hand, has one main advantage- avoidance of a linear donor site scar; and a secondary advantage- ability to harvesting body hair for transplanting into the scalp. The total donor supply available by FUE is reduced from that of strip procedures. The yield of hair growth is less than that of strip, sometimes not a lot but almost universally, due to the removal of the grafts as opposed to them being carefully dissected out under the microscope.
    I also hugely object to your statement that with the NeoGraft the grafts are more closely matched up to the recipient sites in terms of size than they are with FUG- are you suggesting that my recipient sites that are cut with hand-made blades 0.5 to 0.7, occasionally 0.8 mm in size, do not equal let alone exceed the ability of the NeoGrafts to exactly match up the size of my grafts that are cut with my team of 15 assistants who average 7 plus years of dissecting experience?
    If I was a neophyte hair transplant surgeon looking to build up a practice, without the tremendous investment required to build up a team of excellent assistants (that can take years or many thousands of dollars or both) I too would consider purchasing the NeoGraft, both for its ability to bypass for the most part the need for building up a team as well as the marketing advantages. However, this marketing- which clearly you are doing - needs to be done honestly.

    Jeffrey Epstein, MD, FACS
    Miami and NYC
    Jeffrey S. Epstein, MD
    Foundation For Hair Restoration

  5. #15
    Senior Member blowmeup's Avatar
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    If the Neograft is a better way to have a hair transplant, then we will eventually all find out about this. I find it distasteful for Hudson to come here and make accusations about the motives of forum readers and doctors to try to throw us off the scent of what is really going on. Hudson is afraid that he will lose business because the pros and cons of the Neograft are being openly discussed by people who are interested in this stuff.
    Why is Dr. Epstein’s opinion any less valid then yours Hudson? Like I said, if I was a doctor and wanted to make a lot of money fast, I would buy the neograft and start doing hair transplants. It look easy to learn and people are generally very trusting of doctors so I would assume it would be an easy sell to people who don’t do their research. Maybe this is why you are so frustrated?

  6. #16
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    Default Response to Dr. Epstein

    Dr. Epstein, I agree with many of your comments especially the part about having an aesthetic eye, which I think you mean artistic ability, and I also agree about the passion part. These are gifts some people get as a result of how they are wired genetically, and by your sound reputation it sounds as though you have such gifts. I also agree that the NeoGraft is a tool and needs a doctor to work with it. However, this tool helps the doctor to overcome some of the challenges that a manual FUE procedure presents. By using the NeoGraft device, a doctor can greatly reduce the transection rate and the amount of time and technicians required to do a manual FUE procedure. As a result the price of a NeoGraft procedure can be reduced since a NeoGraft procedure tales considerable less time than the same manual procedure. This is important since a manual FUE procedure was out of the financial reach of many patients due to the time factor.

    My response to this site was based on my belief that everyone has the right to pursue their goals without others pulling out sirens to dissuade the public from going to them because they are new at something. If those who send out the sirens are facing change in their industry, or new competition in their field of expertise then the motive for those who are sounding the sirens becomes suspect. Given the negative hype, which consisted of false assumptions, misconceptions and false information which was generated on many forums about NeoGraft, I do not want to see this happen to doctors who are buying the NeoGraft device. A general negative warning such as the one given on this site, opens up other issues. For example, the warning does not include that often “experienced doctors” are resistant to make changes in the way they do procedures for their own personal reasons, such as not wanting to retrain themselves in a new, more patient - friendly procedure or invest in a new device when they can earn the same revenue doing an older procedure. This resistance to change will often motivate some doctors to find fault with other doctors who obtain the new device, and issue warnings without taking the full situation about the capability of these doctors into account. What I am referring to is that not only Spencer Kobren issued such a warning, but there have been "experienced" hair restoration doctors and different forum members trying to give the same message.

    Furthermore, in this case, if most of the experienced hair restoration doctors are not taking the lead to incorporate the NeoGraft device into their practices, and offer patients the FUE procedure, which is a much more beneficial procedure, or at least offer patients the choice of which procedure they wish to have, then those patients, who want an FUE procedure with the NeoGraft will need to find a doctor who is offering the newer, more beneficial to the patients method on the NeoGraft device. It is also important to remember that the NeoGraft device simplifies the FUE procedure and the learning curve is therefore greatly reduced. An Fue hair transplant with NeoGraft is not as dependent on the skill of the doctor as when a doctor does manual FUE. Furthermore and this is very important is that many of the procedures and techniques that a Strip doctor has to learn for Strip surgery are not part of an FUE procedure. For example, removing an elongated piece of scalp, which is a surgical procedure, that requires sufficient practice so as not to cut nerves or arteries, or dissecting follicles and trimming them, are totally absent in an FUE procedure. By sending out a general warning about new doctors that have NeoGraft, a disservice is done to many of them who are already very competent through training, their own experiences, the simplified NeoGraft procedure, and any talent they may have to do excellent work. What is most unfair is that no light is cast on “experienced” hair restoration doctors who might be less than competent regardless of their experience, or new doctors training in he Strip method.

    A blanket warning does not give enough recognition to the complexities involved in who or what makes a good hair restoration doctor or not and so everyone in a targeted group is impacted by these warnings. Experience is only one of the components of a proficient doctor and many experienced doctors never reach the level of proficiency hoped for in a doctor in general. One needs to take into consideration that if a procedure is simplified, as with the NeoGraft device, the experience story changes. Hair restoration doctors do seem to stress the need for experience doing hair lines, however, it is also my impression that, with everyone having a different hairline, (taking into consideration age, face shape, ethnicity etc.) the ultimate result depends more on the doctor’s personal aesthetic sense about what constitutes an excellent hairline. This fact does not negate that doctors can learn to do proficient hair lines in a reasonable amount of time that still satisfies the patient.

    There is always someone more talented than someone else. But everyone, short of doing harm, is entitled to do their career and not be subjected to warnings. I need to remind readers that many of the doctors buying the NeoGraft are experienced hair restoration doctors already, many coming from other specialties such as Dermatology and Plastic Surgery and others have done hair restoration in the past and want to resume doing them with the NeoGraft device and this is their right.

    I do believe sirens should be sounded once a doctor is identified as being incompetent, and only then. This is more fair reporting than casting doubt on a whole group. Unfortunately,identifying incompetent doctors does not always occur and society does not have a good format for how to make the public informed about incompetent doctors in every field. So in the end we all agree patients must do their own due diligence to find the best doctor they can and if they want a NeoGraft FUE hair restoration procedure they will have to pick from those doctors who offer that procedure, many of which are as I stated already very proficient in hair restoration.


    It Being new at something is a relative thing. How much time and training is not considered new? Those doctors who have the of the doctors who have purchased the NeoGraft are not out practicing Of course it is the patients ultimate responsibility to choose a good doctor, and if a not good doctor is identified I believe the public should be warned. But until then it is, in my opinion,
    It is our intention, with the NeoGraft device to educate the public that now with NeoGraft, a hair transplant procedure is a more simple non invasive procedure and hopefully, those patients, who may have wanted a hair transplant but were not willing to undergo the surgical procedure of the Slit method, will consider doing so with the NeoGraft device. We have heard many patients express this to us.

    And why go after the medical device company? They are doing their job, in fact, most medical device companies go beyond their responsibility to only train on the device, for reasons that too lengthy to enter into here. And since when was it wrong to want to make revenue? It was my impression that one of the major reasons for entering hair restoration for doctors who were all educated in other specialties is because this field can be very lucrative. There may be those doctors impassioned by doing hair restoration and I have met some, but do you think every doctors is impassioned to do hair restoration?
    It is wise for patients to seek out the best possible doctors they can. However, I do not agree with posting sensational, incorrect and misleading headlines and posts as many forums have done, because the people posting them, I believe feel they have something to lose, which is patients who may decide that the FUE procedure is for them. Spencer Kobren is not a doctor, but he speaks with a lot of doctors and we have heard this sentiment before about NeoGraft being bought by inexperienced doctors. This is not totally accurate, as many doctors in other specialties who are buying NeoGraft do hair restoration, and some did so in the past and want to start again. But in any case, since everyone was new in hair restoration at one point in time,

  7. #17
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    Default Problem with last Post

    The post I just sent was to have ended at the paragraph that reads:

    I do believe sirens should be sounded once a doctor is identified as being incompetent, and only then. This is more fair reporting than casting doubt on a whole group. Unfortunately,identifying incompetent doctors does not always occur and society does not have a good format for how to make the public informed about incompetent doctors in every field. So in the end we all agree patients must do their own due diligence to find the best doctor they can and if they want a NeoGraft FUE hair restoration procedure they will have to pick from those doctors who offer that procedure, many of which are as I stated already very proficient in hair restoration.

    The rest of the post was meant to be another post that I was editing in response to another forum site. I had both posts on the same page and accidentally both posts were cut and pasted to your site. If you can make sense of the other post, since it is in rough and unedited you will see I am
    addressing strong opinions on those forums also.

  8. #18
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    Default Response to Dr. Epstein re FUE vs. Strip

    Dr. Epstein,
    With respect to your comment : “I also hugely object to your statement that with the NeoGraft the grafts are more closely matched up to the recipient sites in terms of size than they are with FUG- are you suggesting that my recipient sites that are cut with hand-made blades 0.5 to 0.7, occasionally 0.8 mm in size, do not equal let alone exceed the ability of the NeoGrafts to exactly match up the size of my grafts that are cut with my team of 15 assistants who average 7 plus years of dissecting experience?”

    I did not imply in my post that you personally and your team do not do an excellent job of matching up sites and grafts. I was speaking generally. I am sorry if you thought my remark was directed personally to you, it was not. As I mentioned before, your reputation alone would make one certain that when you undertake a procedure it will be done properly. Your standards however do not necessarily cross over to other technicians working with other doctors. What you have confirmed is my point that NeoGraft simplifies the hair transplant procedure, making it possible for doctors to do a hair transplant without having to worry about training many technicians to produce grafts that are of good quality. A Strip procedure is not only dependent on the skills of a surgeon, such as yourself, but also in your case on 15 other individuals who separate the grafts from the piece of scalp that was removed. The method NeoGraft uses automatically extracts grafts the same size, and does not depend on technicians to do so.

    I would also like to address your comment: “Now you have lost credibility hudson, making one eroneous statement after another.” Dr. Epstein, I do not wish to lose credibility with you. I would like to have a differing opinion and not lose credibility with you as I respect your work. It is a fact that there is quite a bit of controversy as to whether one procedure is more beneficial than the other. The facts about the two different procedures are often in dispute as well. I want to direct you to post that Dr. Cole wrote, also an ISHRS member titled ‘FUE vs Strip’ on this site at http://www.baldtruthtalk.com/showthread.php?t=1299.
    You know where NeoGraft stands on this Topic. Here are Dr. Cole's comments:

    Dr. Cole writes:
    “I've been advocating the FUE procedure over a strip procedure since 2003. The rationale for this is based on experience. Prior to advocating the FUE procedure, I had performed over 8000 strip procedures and i had seen the negative sequelae of multiple strip procedures over time. The first thing to consider is that a properly performed FUE procedure will yield 2.9 hairs per graft in my hands. This is far more than the 2.0 hairs per graft that a strip procedure will produce in expert hands in an average case.

    The next obfuscation you will encounter with strip surgeons is that a larger procedure is better off with a strip procedure. An average donor area has over 16,000 follicular units and there is no reason you cannot remove 25% or more with FUE. An average donor area that yields 4000 grafts averaging 2.9 hairs each is certainly going to yield more hair (and coverage) than the same 4000 grafts averaging 2.0 hairs per graft. The next thing to recognize is that the average strip transplant achieves it's graft count by splitting 3 and 4 hair grafts into 1 and 2 hair grafts. Certainly, you can produce more grafts by fractionating full size follicular units into smaller grafts. (if you read the rest of article which I did not include for brevity, it will explain why Dr. Cole states this about the grafts. It has to do with the technicians.)

    The survival of strip and FUE grafts in capable hands is the same. The number of hairs per graft is greater with FUE. The potential for negative scarring is greater with strip surgery. The potential coverage from either procedure is better with FUE based on similar numbers of grafts.
    In 2002 FUE was essentially non-existent. In 2006 it was 7.4% of all hair transplant surgeries. In 2008 FUE was 10.4% of all hair transplant surgeries. In due course, it will continue to grow.

    if you are confused and uncertain what to do, wait. In time your choices will narrow. Certainly, it is very likely that anyone under 30 will not have a strip as their initial surgery. Of course this is what i have been advocating for over 6 years.”

  9. #19
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    From everything I have read, including the history of FUE on Dr. Coles website, and on one show when Dr. Bauman called in, it was Spencer Kobren who introduced FUE to North American Hair transplant doctors and called for its practice and acceptance. Dr. Epstein posted that he does three FUE per week and I’ve heard Spencer talk about Dr. Feller's fue machine, and Dr. Harris’s also. So I don’t think Kobren, Dr. Epstein or any good doctor is anti FUE.
    I think that that they are anti BS

    Hudson, your arguments sound like those of a salesman and you still have not told us who you are. I don't really care, but I do find it odd that you have some much to say but will not divulge your identity.

  10. #20
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    Last night Spencer Kobren said on his show that he was going to invite the Neograft people and one or two FUE doctors to talk about the NeoGraft and debate their views on it. I wonder if hudson is going to join in?
    Will you be there Dr. Epstein?

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