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  1. #41
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    I am fairly certain if you ask the top fue doctors in the world of which there are less than a handful they would say that the .75-.85 would suffice in most cases. Sure I would agree with you regarding afro hair and coarse Asian hair, maybe I should have been a little more specific. I meant in the majority of cases which are not afro hair and for the most part of average thickness. But you make a good point and hopefully clinics are letting these patients with extremely curly or coarse hair know they are not good candidates as a larger punch would be needed and personally I would advise against it.

    I gave a range of .75-.85 but preferably the smaller punch would be used unless it was necessary to move up in size, again maybe I should be more specific. I tend to write fast and should slow it down as sometimes my message might be confusing.

    I do not agree with you that there are more competent fue doctors in the world than I have stated, just my opinion.

    I am familiar with MUGS and FUGS and I have had the unfortunate experience of having multiple MUGS placed into my hairline. I don’t mean to offend here but acronyms to me are just a load of horsesh*t. They are used to make something sound more complicated than it really happens to be. No different that these multiple acronyms for FUE. Let’s see we have FIT, FUSE, SFET and whatever else anybody just decides to come up with. It’s just part of what makes this a horsesh*t industry in my opinion, just a little too much deception.

    The number one reason why FUE has poor yield is too many doctors are trying to perform it but simply do not have the patience and skill. So they look for ways to speed it up or somehow make it easier. Most of the damage is being caused by these doctors trying to use motorized devices exactly the opposite of what you have stated but that is my opinion. It’s not a coincidence that all the top FUE doctors with the highest yield have one thing in common, manual extraction.

    I’m not sure what your point is with the strip comment you lost me there. I asked if you would be willing to let the robot extract a fue from your face using a .95 punch to make a point. It’s too large and would likely leave a white dot no different than the scalp. So why use it on the scalp if a skilled doctor is available that can use a smaller punch lessening the chances of scarring.

    Let me add that I do not work in this industry so I can understand since you make your living in it you have strong feelings. I have equally strong feelings as I have learned over 25 years just how corrupted it is with what can only be described as top heavy in greedy psychopaths. Those that are ethical in this business make up a very small percentage in my opinion.

    I will continue to state my opinion as it helps to keep the industry honest. I received 1 pro bono offer by a clinic that I happened to have thought was the best in the world at FUE. I respect that they reached out and gave me a hand up because it is my personal philosophy. My words might sometimes seem harsh but I would be the first person to extend my own hand to help someone in need and if you read my story you would know that I gave up half my pro bono offer to 2 other patients in need as I couldn’t leave someone behind and I have paid for the additional procedures.

    I am a person of modest means but I have every intention of getting the funds together that are equal to or greater in value of that first pro bono offer and somehow passing that on to another repair patient in need sometime in the future. That to me is helping patients and I would like to see others who work in the periphery of this industry do the same.

  2. #42
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    This an past BHR posting that someone recently revived on another forum. I believe it was another clinic but I will cut and paste it here as it might be helpful.

    Follicular Unit Extraction/Donor Management & Punch Size



    The safety zone for FUE can be measured and sectioned in to three areas; simply both sides and the back, then the total surface area calculated. The density is then measured in each area and an average overall density taken using a magnifying densometer; the natural FU groupings measured and an average taken including miniaturisation of hair in the donor safety zone.

    The number of grafts available for extraction can then be calculated; taking into consideration not over harvesting and leaving the donor “moth eaten”. To ensure not to over harvest there must be a limit to the number of FU that can be removed per cm2; removing much more than 27% per cm2 will noticeably thin the donor area and potentially cause obvious visible scarring over a large area of the donor.

    The punch size used will affect the number of FU that can be safely removed; incorrect punch can increase transection of the removed FU, damage surrounding FU cause larger and more visible scarring. With a small punch there is a risk of transecting the FU being removed if the group is too large to be encompassed by the diameter punch, therefore cutting the FU causing the loss of a hair from that FU and reduce the total hair numbers placed. When a large punch is used it has the possibility to cut into an adjacent FU if the density of FU is high. This either means taking two genetic groups at the same time or splitting and transecting one of them, for example two 2 hair FU or maybe a 3 hair and a 1 hair in the same punch OR maybe taking an intact 3 hair FU and dissecting another and a likely conclusion is killing a hair and traumatising the surrounding hairs.

    Included in this problem is the pattern of extraction; to use a large punch and over harvest in an area will leave obvious thinning and density changes in the donor; this will result in the donor potentially being too thin for further extraction even from a relatively small number being removed; say 2000; this has been called “hairless areas” but simple is larger scarring be it obvious or not OR overharvested areas.

    The larger the incision made into skin has the potential for greater scarring; obviously the skill of the incision will have an impact but simply a larger hole is made in the skin tissue and more fibrosis is caused and greater pigmentation alteration; thus making the scarring potentially more visible and larger. If the larger punch is used and the extraction pattern not monitored to approximately 27% the donor can visibly lose density, because a “moth eaten” look on the scalp and make it almost impossible to harvest any amount of grafts.


    Below is a section of a report made with Dr Bisanga a few years ago discussing the FUE procedure and the pros and limitations; it shows the effect of a 1.1mm punch on the surrounding FU and smaller punch on larger FU groups; also that a .75 mm punch can surround a 4 hair FU without transection and thus cause less potential scarring.

    Follicular Unit Extraction when the limitations are adhered to can be an excellent form of hair transplant. The limitations are the use of the correct punch size, not to extract a combination of FU in one punch; not to over harvest the donor to extract more FU and leave the donor thinned.


  3. #43
    Senior Member gillenator's Avatar
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    Well now you're making more sense being more specific. And you know I do agree with most of whay you are stating.

    Again, I see far more work than you do and one thing for certain is that you are dead wrong about there NOT being more and more doctors competently doing FUE. And the field is growing in North America unlike anything else that I have seen in the past.

    Sure it's true that the best results right now are being done manually but SO ARE THE WORST RESULTS. You forgot to mention that or possibly I missed it in your past posts.

    As I said before, robotics have not yet arrived to its fullest potential obviously and also why there are far more docs doing it manually. We need to give both methods more time for these surgeons to develop their proficiencies and potential.

    And thanks for putting up the BHR post which confirms what I have been saying and also to some extent what you are saying. Actually you have made many valid points and some which I felt need some fine tuning.

    Listen, FUGS and MUGS are not just some slick terms for FUE as you seem to be implying, they represent large FU "groupings" or multiple unit groupings.

    And I do think where we all agree is that yes in most cases of FUE extractions, patients with average FU sizes and hair characteristics can have a very large percent of their FUs extracted with the smaller punches. And thank you for finally acknowledging that the best approach is to match punch size to the FU so not to transect or destroy the hair.

    Let me say in conclusion that I very much respect and appreciate your giving up a pro bono to another patient. And you have been a very big help on these forums which I think that I have acknowledged before. If not, please allow me to do that now.

    Lastly, no I am not "employed" in this field. Each doctor at my signature pays a nominal amount to me as an independent advocate to operate my office whic is open to any patient. But I don't get any paycheck for what I do, I don't earn any commissions, no bonuses, no other compensation whatsoever. I can faithfully and honestly tell you that I have never in 31years ever charged any patient one penny for my help. And there have been more than a few that I have put much effort and assistance in getting corrective resolve to their complex cases.

    I am also a four time HT patient still battling hairloss myself. So please don't insinuate that I am in this for the money because I am not. I am here to help other hairloss sufferers just like myself and you topcat.

    At the same time with my background and knowledge over the past three decades, don't you think that I could make lots more if I chose to do so? But I don't choose to start my own website and hairloss community, nor do I choose to work as a consultant, salesperson, whatever.

    I am semi-retired and actually serving my community as a "volunteer" if you really want to know. I do not get paid for that either which takes up a fair amount of my time especially in hospice care. I am also a terminal lung cancer survivor living with one lung now. But my passion like you has always been people because people are what matter and I truly hope my posting history in these forums over the years prove that.

    Anyway topcat, you're a good guy and hope you stay around! Again thanks for your insights and contributions my friend.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

  4. #44
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    didnt have time to read this whole thread but I am going to speak on REAL WORLD EXPERIENCE.

    I just got home from Dr. Harris office and he performed a test on my head to make sure I was a good candidate due to my mix nationality.

    Thankfully I am good candidate

    My head is still numb

  5. #45
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    Okay we can agree I do believe a punch range is best but I believe the punch range to be between .75-.85 If the situation calls for a larger punch then the patient should be advised and also have a clear understanding of the possible implications of using that larger punch.

    As far more doctors performing fue at a very high level I would have to still disagree with you. I also believe results are not only technique related but also doctor related so of course I would believe there are plenty of doctors using a hand punch and are doing a tremendous amount of damage but that in my opinion is skill related.

    I wasn’t trying to imply that MUGS and FUGS were slick terms for fue but simply that the use of acronyms can sometimes be used to confuse or simply make something sound more complicated than it happens to be and it’s not specific to the hair transplant industry.

    As far as how much you make or can make from this industry I have no reason not to believe what you wrote. Speaking just for myself I can honestly say I have made zero nor do I care to make one penny from this industry. I understand that sometimes I might come across as very harsh in my opinions but we are all presenting what we know from our own unique experiences.

    Gillenator you sound like a good guy so please do not take my comments as personal attacks because that is not their intention. I hope you have gotten past your health issues and if I can be of any help I would be more than happy to offer up what I know. Something I have learned in life as I have gotten older and we are probably close in age as I will be 50 soon. Diplomas, awards, designations etc does not necessarily make one and expert and this is not directed towards you. For me it’s more important to show the proof and let that do the talking.

    We can disagree and state our opinions and I wouldn’t take it personally. It’s good for forum members to read and in the process everyone learns something.

  6. #46
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    Quote Originally Posted by amadeus View Post
    That’s very pricy. These doctors make a lot of money but one thing Spencer Kobren says all the time when people bring this up on his show is that people will pay what the market will bear. It’s the law of economics he says, and he’s right. It’s not fair, but I guess there are plenty of well off guys who will pay these outrageous prices. I’m not one of them and am hoping that this robot will eventually help to drive down the cost to maybe 5 dollars per graft like regular hair transplants. Spencer if you are reading this please discuss this on Friday’s live hair transplant show.
    Dr. Cole does seem a bit threatened by this robot, but I probably would feel the same way if I spent my life trying to improve hair transplants only to have the rug pulled out from under me by new technology. He’s only human like the rest of us. I still think he’s one of the best at FUE but so is Harris and now that I read that Dr. Bernstein is going to be using this robot, I can't help but think that it might me the best way to do FUE.
    Yah, I agreed! these Dr are sucking too much money out of us. I will also wait for the price to come down.

  7. #47
    Senior Member gillenator's Avatar
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    topcat,

    Thanks for your insight and discernment. Actually we both agree on far far more issues than disagree. I believe we are both well intended in this industry. That is why I have never ever charged any patient one penny, just like you.

    Listen, if you are ever in this area, let me know. You are most welcome in my office anytime and would love to chat and show you what I do for patients and then you'll see first hand.

    That is an open-ended invitation my friend.

    Take care...
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

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