For less than 3000 grafts

Hair Transplant
21

» »
» » bvertotty said "It has been generally accepted that FUE produces higher
» » hair count per graft. This is due to the nature of a doc being able to
» » cherry pick larger grafts. There was a study presented about this by
» dr.
» » Mwamba (if I am not mistaken) at the ISHRS in San Diego. So this is not
» » BS, this is fact. "
» »
» » Well I think it’s bull sh*t, can I see the study ? Everybody knows if
» you
» » want to max out your donor, the only way is by strip.
»
» I thnk it is not only insulting to refer to this study / idea as bull it
» also shows a lot of ignorance.
»
» The comments by bevrotti have been explained over and over again on these
» boards and it is not rocket science. At least try to get to grips with an
» idea before becoming critical about it.
»
» If you can pick a follicle then a follicle with the most hair can be
» picked. When performing strip this cannot be done.
»
» It may be that strip produces better results but that does not impact on
» the truth of these comments and you will need to look for other reasons.

Marco,
Of course with FUE you can handpick your grafts and the average as bverotty states can be close to 3 vs 2 in FUT, fair enough. Marco, bverotty was really implying was after he gets the grafts to be split or something, as well as hand picking the grats.

The problem I have is this statement from bverotty:

“Let there be no mistake : FUE megassesions are for anyone who seeks hair transplants without having to worry about scarring or other nasty side effects of outdated procedures”

  1. First he is implying that FUE is for anyone, those with a NW2 and those with a NW6 and beyond.
  2. FUE produces no scarring according to him or any nasty effects as a result of using outdated procedures which of course he is implying FUT. On what world is he living? One thing is working for a clinic as his representative and another choosing your words wisely, realize that the vast majority of top docs use FUT, and some but few use also FUE. Also understand that FUT and FUT are 2 compatible techniques and a top doc as surely the one you represent SHOULD know when to use one and when to use another.
    I am aware that you are into FUE megassions, but at least recognize its limitations which are many. This is a forum for begginners and people who have been around the block for a long while to exchange unbiased ideas.
  3. I am still waiting for you to reply to my previous post, and you know what, I have a feeling you wont, why? simply cause you dont have an answer.

Personally I think you should educate yourself more before you come out here and disinformn to say the least many forum members.

These last comments are meant for bverotty, not for you marco.

22

» »
» » bvertotty said "It has been generally accepted that FUE produces higher
» » hair count per graft. This is due to the nature of a doc being able to
» » cherry pick larger grafts. There was a study presented about this by
» dr.
» » Mwamba (if I am not mistaken) at the ISHRS in San Diego. So this is not
» » BS, this is fact. "
» »
» » Well I think it’s bull sh*t, can I see the study ? Everybody knows if
» you
» » want to max out your donor, the only way is by strip.
»
» I thnk it is not only insulting to refer to this study / idea as bull it
» also shows a lot of ignorance.
»
» The comments by bevrotti have been explained over and over again on these
» boards and it is not rocket science. At least try to get to grips with an
» idea before becoming critical about it.
»
» If you can pick a follicle then a follicle with the most hair can be
» picked. When performing strip this cannot be done.
»
» It may be that strip produces better results but that does not impact on
» the truth of these comments and you will need to look for other reasons.

Ignorant are those who say it cannot be done using strip. Whenever you remove a strip, you are guaranteed to capture everything in there.

23

» “Let there be no mistake : FUE megassesions are for anyone who seeks
» hair transplants without having to worry about scarring or other nasty
» side effects of outdated procedures”

On average how many grafts can one FUE megasession give us ?

24

Before anyone as a hair transplant,always assume the worse.

How many strip repair cases do we see?

How many FUE repair cases do we see?

If I personally was going to have hair transplant,I’d go for the option of FUE.Then if I actually lose more hair I’d be able to have a shaved head.Hopefully the hair shadows wouldn’t look to out of place,but a scar would be totally unacceptable.

I was a dreamer.I actually thought we’d be seeing some HM results by now,but all the time I was hoping I have kept an eye on hair transplant forum.

A shaved head can look better,than some transplant I’ve seen on here,but we do see some good results as well.

25

» » “Let there be no mistake : FUE megassesions are for anyone who seeks
» » hair transplants without having to worry about scarring or other nasty
» » side effects of outdated procedures”
»
» On average how many grafts can one FUE megasession give us ?

We can transplant 3000 grafts on just about any virgin scalp, unsplit of course.
Then we would wait 2 to 6 months to let the donor area heal. AFter healing we re examine the donor area and inform the patient about his future possibilities. For the average patient we find that 4000 to 6000 grafts, unsplit, are achievable.
Maybe in a year or so we start seeing more patient return for more work after 4000-6000 grafts. At this point we just dont know if more is possible, but maybe it is ? I have a feeling that it is, but I rather wait to get more data in.
:slight_smile:

26

» »
» » bvertotty said "It has been generally accepted that FUE produces higher
» » hair count per graft. This is due to the nature of a doc being able to
» » cherry pick larger grafts. There was a study presented about this by
» dr.
» » Mwamba (if I am not mistaken) at the ISHRS in San Diego. So this is not
» » BS, this is fact. "
» »
» » Well I think it’s bull sh*t, can I see the study ? Everybody knows if
» you
» » want to max out your donor, the only way is by strip.
»
» I thnk it is not only insulting to refer to this study / idea as bull it
» also shows a lot of ignorance.
»
» The comments by bevrotti have been explained over and over again on these
» boards and it is not rocket science. At least try to get to grips with an
» idea before becoming critical about it.
»
» If you can pick a follicle then a follicle with the most hair can be
» picked. When performing strip this cannot be done.
»
» It may be that strip produces better results but that does not impact on
» the truth of these comments and you will need to look for other reasons.

Dr. Bisanga said it is only safe to harvest 25% of the donor using fue or the donor will start to look visibly thin. Well, cherry picking over just 25% of the donor isn’t going to leave us with that many useful grafts.

27

» » »
» » » bvertotty said "It has been generally accepted that FUE produces
» higher
» » » hair count per graft. This is due to the nature of a doc being able
» to
» » » cherry pick larger grafts. There was a study presented about this by
» » dr.
» » » Mwamba (if I am not mistaken) at the ISHRS in San Diego. So this is
» not
» » » BS, this is fact. "
» » »
» » » Well I think it’s bull sh*t, can I see the study ? Everybody knows
» if
» » you
» » » want to max out your donor, the only way is by strip.
» »
» » I thnk it is not only insulting to refer to this study / idea as bull
» it
» » also shows a lot of ignorance.
» »
» » The comments by bevrotti have been explained over and over again on
» these
» » boards and it is not rocket science. At least try to get to grips with
» an
» » idea before becoming critical about it.
» »
» » If you can pick a follicle then a follicle with the most hair can be
» » picked. When performing strip this cannot be done.
» »
» » It may be that strip produces better results but that does not impact
» on
» » the truth of these comments and you will need to look for other
» reasons.
»
» Dr. Bisanga said it is only safe to harvest 25% of the donor using fue or
» the donor will start to look visibly thin. Well, cherry picking over just
» 25% of the donor isn’t going to leave us with that many useful grafts.

OK, Thank God someone with common sense coming out telling the obvious!!
Wake up people, FUE megassession regardless of what they try to sell you is not going to save you.
I wish, Jotronic or someone from Armani, perhaps even Bisanga would come on, although highly unlikely

28

» » Dr. Bisanga said it is only safe to harvest 25% of the donor using fue
» or
» » the donor will start to look visibly thin. Well, cherry picking over
» just
» » 25% of the donor isn’t going to leave us with that many useful grafts.
»
»
» OK, Thank God someone with common sense coming out telling the obvious!!
» Wake up people, FUE megassession regardless of what they try to sell you
» is not going to save you.
» I wish, Jotronic or someone from Armani, perhaps even Bisanga would come
» on, although highly unlikely

There obviously are different interpretations on FUE and we have our own protocol when harvesting, and others have theirs. We believe as I have said in the previous thread that donor management and if you want to leave it as unblemished as possible and with options for FUE in the future it is prudent to stick to approx. 25-27% and if all goes in the person’s favour maybe get to 30.

That does not mean every candidate is suitable in the first place; if you take a man possibly heading towards NW6 with fine hair characteristics, lower than average number of hairs per FU and density say 60; maybe he does not make a good candidate for solely FUE, and FUE alone if in the future he requires more. When hair characteristics go against you and you have to look to the future it may not be the best idea to tap out your donor in one shot and forget about later; the forums are made up of stories like this. That again is assuming you keep within certain extraction parameters; it’s ok to say that FUE can get a greater hair count from FU but what if the hair count is naturally lower anyway, do you extract more per cm2 to reach a decent number to achieve the result?

Also the hair per graft debate; if you “cherry pick” all 2,3 & 4 hair FU then obviously the hair count per FU will be higher, but this is purely playing with numbers; the fact almost all hair transplants start with designing a hairline and then work back means you will require a % of single hair FU’s and this balances out over the procedure. The hairs per FU will be different from person to person as it will be on various areas of the scalp, and then will equate to what you require to do the procedure. For example, if you take a hairline, maybe 600 odd single hair FU will be required to design only the first few mm’s; then behind the build up of greater thickness with firstly 2 hair and 3 and 4 hair FU.

Like I said, this is our view, obviously some differ in opinion but from the results we see and consultations we have performed very very few who need extensive number of grafts are going to be good FUE candidates; WITHOUT OVER HARVESTING. Then you have the debate what is over harvesting, as some feel this can reach 50% with no risk.

29

Philb, can you help me understand this or confirm if this is correct?

I know FU means follicular unit. 1 FU will contain more than 1 follicles, and 1 follicle can sometimes have 2,3, 4 hairs ?

I got confused when people say having 2,3,4 hairs, are they referring to 2,3,4 hairs for 1 follicle or for 1 follicular unit ?

30

» Philb, can you help me understand this or confirm if this is correct?
»
» I know FU means follicular unit. 1 FU will contain more than 1 follicles,
» and 1 follicle can sometimes have 2,3, 4 hairs ?
»
» I got confused when people say having 2,3,4 hairs, are they referring to
» 2,3,4 hairs for 1 follicle or for 1 follicular unit ?

Hi hair911

You are correct, FU is a follicular unit; and may contain 1,2,3,4 and very occasionally 5 hairs. Hairs grow in these natural bunches and it is these that are either separated from the strip if FUT is used or are removed individually from the scalp if via FUE. In respect of a hair transplant you need a healthy mix of all FU sizes to reach a result because splitting them to “manufacturer” or creating a DFU (double FU) is not ideal in gaining the result.

When looking at a persons’ characteristics and suitability for a hair transplant many first look at their density of FU in the donor (that being the number of FU bunches per cm2 NOT the amount of hairs), this obviously does play a very important factor. But what must be taken into account are the number of hairs per FU also (as well as hair characteristics); you can take two men, both the average same density of FU but one may have a larger number of hairs per FU and therefore aid in the transplant in terms of coverage and density, whereas the man with less hairs per FU may require more FU to cover the same surface area because the physical hair numbers are less even though the same number of FU may be used.

Again, this is another factor that makes a hair transplant very personal; and although pictures/videos are good to get a representation of work they are not necessarily representative of your personal hair characteristics.

This blown up image of the scalp and FU groupings may show it better, I have circled three FU, one containing 1 hair and the others two and three hairs.

HairperFU.jpg449×602

31

Ok I am confused too. So if the FU has 3 hairs, it means it has 3 follicles?

32

» Ok I am confused too. So if the FU has 3 hairs, it means it has 3
» follicles?

Hi reiner

Each hair grows in a follicle and each follicle is part of a Follicular Unit, be it single or multiple. The follicle is the protective outer sac that houses and the hairs form in, and that is then surrounded by the fatty tissue, each containing the important genetic information allowing the hair to grow. Attached to each also are the nerve receptors, muscle and sebaceous gland that contains the natural oils secreted from the scalp and lubricates the hair shaft.These are important to ensure that the hair behaves in the same manner even when moved, for example the feeling of pulling on the hair.

Here is an illustration of this for example; showing the various size FU cross sectioned;

33

Hi all,

I scanned this thread somewhat quickly so, please forgive me if I have missed any points.

“Let there be no mistake: FUE megassesions are for anyone who seeks hair transplants without having to worry about scarring or other nasty side effects of outdated procedures.”

Strip is not an outdated surgery at this point in time. There seems to be a misconception that FUE is progressing at a breakneck speed, while strip harvesting with microscopes is not advancing. Both types of surgeries have a place, today anyway, and I do not think the suggestion to the contrary is very helpful for patients looking to undergo surgery. Trust me, strip and FUE have come a long way even from a few years ago. I just hope everybody can find a great doc.

Regarding Dr. Mwamba’s study, it is an excellent one. Please make no mistake about it! He looked at hundreds of cases of FIT/FUE and noted that the grafts on average have more hairs in them. The study was done in order to analyze the procedure and share the finding with other doctors. This is not WHTC market material. It is just something we recognize as beneficial for patients and, therefore, we apply it in surgery when possible. Please remember that calculated density is only one part of getting a great result. A surgeon may plant many grafts with high calculated density but, if the surgery is not performed with great care by doctor and staff, those “bonus” hairs may not grow well. At that point what have you accomplished? Nothing. I love Dr. Mwamba’s work, but, in my mind the hairs-per-graft piece is a mere footnote (although this ratio happens to be very favorable in Dr. Mwamba’s hands). The work is tops (and indeed “awesome” in the true and rarely used sense of the word) because he is hard worker with a great eye for what looks natural. He stays with the patients, monitoring the surgery in every aspect so that quality remains high. He wants patients to be happy, he listens, and has the skills to deliver.

So while that study is interesting, and accurate, it should not be used as FUE-propaganda. Calculated density is one part of larger picture. A clinic needs the whole package to deliver great results on a consistence basis. I trust Dr. Mwamba to give his patients top results. I also trust a small handful (very small) of other elite docs to do the same. Interestingly, some do strip, others FUE, and still others, a combo.

34

» » Ok I am confused too. So if the FU has 3 hairs, it means it has 3
» » follicles?
»
» Hi reiner
»
» Each hair grows in a follicle and each follicle is part of a Follicular
» Unit, be it single or multiple. The follicle is the protective outer sac
» that houses and the hairs form in, and that is then surrounded by the
» fatty tissue, each containing the important genetic information allowing
» the hair to grow. Attached to each also are the nerve receptors, muscle
» and sebaceous gland that contains the natural oils secreted from the scalp
» and lubricates the hair shaft.These are important to ensure that the hair
» behaves in the same manner even when moved, for example the feeling of
» pulling on the hair.
»
» Here is an illustration of this for example; showing the various size FU
» cross sectioned;
»
»

I can see why this confuses people. I think his question is whether there can be only 1 hair for each follicle.

35

» I can see why this confuses people. I think his question is whether there
» can be only 1 hair for each follicle.

Yes, in other words, 1 follicle will always be 1 hair. 1 follicle cannot produce 2,3,4 hairs? Am I correct?

36

» » I can see why this confuses people. I think his question is whether
» there
» » can be only 1 hair for each follicle.
»
» Yes, in other words, 1 follicle will always be 1 hair. 1 follicle cannot
» produce 2,3,4 hairs.

Hi,
For what I know, each FU (follicular unit) can have from 1 hair to even 5 hairs.
So what is it so hard to understand?
Cheeers

37

» » » Dr. Bisanga said it is only safe to harvest 25% of the donor using fue
» » or
» » » the donor will start to look visibly thin. Well, cherry picking over
» » just
» » » 25% of the donor isn’t going to leave us with that many useful
» grafts.
» »
» »
» » OK, Thank God someone with common sense coming out telling the
» obvious!!
» » Wake up people, FUE megassession regardless of what they try to sell
» you
» » is not going to save you.
» » I wish, Jotronic or someone from Armani, perhaps even Bisanga would
» come
» » on, although highly unlikely
»
» There obviously are different interpretations on FUE and we have our own
» protocol when harvesting, and others have theirs. We believe as I have
» said in the previous thread that donor management and if you want to leave
» it as unblemished as possible and with options for FUE in the future it is
» prudent to stick to approx. 25-27% and if all goes in the person’s favour
» maybe get to 30.
»
» That does not mean every candidate is suitable in the first place; if you
» take a man possibly heading towards NW6 with fine hair characteristics,
» lower than average number of hairs per FU and density say 60; maybe he
» does not make a good candidate for solely FUE, and FUE alone if in the
» future he requires more. When hair characteristics go against you and you
» have to look to the future it may not be the best idea to tap out your
» donor in one shot and forget about later; the forums are made up of
» stories like this. That again is assuming you keep within certain
» extraction parameters; it’s ok to say that FUE can get a greater hair
» count from FU but what if the hair count is naturally lower anyway, do you
» extract more per cm2 to reach a decent number to achieve the result?
»
» Also the hair per graft debate; if you “cherry pick” all 2,3 & 4 hair FU
» then obviously the hair count per FU will be higher, but this is purely
» playing with numbers; the fact almost all hair transplants start with
» designing a hairline and then work back means you will require a % of
» single hair FU’s and this balances out over the procedure. The hairs per
» FU will be different from person to person as it will be on various areas
» of the scalp, and then will equate to what you require to do the
» procedure. For example, if you take a hairline, maybe 600 odd single hair
» FU will be required to design only the first few mm’s; then behind the
» build up of greater thickness with firstly 2 hair and 3 and 4 hair FU.
»
» Like I said, this is our view, obviously some differ in opinion but from
» the results we see and consultations we have performed very very few who
» need extensive number of grafts are going to be good FUE candidates;
» WITHOUT OVER HARVESTING. Then you have the debate what is over harvesting,
» as some feel this can reach 50% with no risk.

Hi Philib,
I would like your insight on the following points.

  1. From your experience from patients coming to your clinic, on average, what percentage end up having FUT vs. FUE (could be 70-30?).
  2. On average, what percentage end up having either FUT or FUE of less than 3.000 grafts, and more than 3.000 grafts.
  3. What would you say to some people who do not mind going to 50% on the donor with FUE leaving the donor over harvested?
  4. In terms of yield or growth, would you say FUT and FUE, same result?
  5. Which of both techniques requires more precision or skill?
  6. What is currently the max amount of FUE grafts done at one session?
  7. Finally, for someone with stabilised hairloss and requiring just 3.000 grafts and asssuming average hair densities, dexture, etc., would you advice on FUE?

Cheers!

38

» Hi Philib,
» I would like your insight on the following points.
» 1. From your experience from patients coming to your clinic, on average,
» what percentage end up having FUT vs. FUE (could be 70-30?).
» 2. On average, what percentage end up having either FUT or FUE of less
» than 3.000 grafts, and more than 3.000 grafts.
» 3. What would you say to some people who do not mind going to 50% on the
» donor with FUE leaving the donor over harvested?
» 4. In terms of yield or growth, would you say FUT and FUE, same result?
» 5. Which of both techniques requires more precision or skill?
» 6. What is currently the max amount of FUE grafts done at one session?
» 7. Finally, for someone with stabilised hairloss and requiring just 3.000
» grafts and asssuming average hair densities, dexture, etc., would you
» advice on FUE?
»
» Cheers!

Hi boris

Just the odd question from you; I will try to be as candid as possible
I can only tell you the % coming dependent on those we consult obviously; some months we may have mainly FUT and then the next can switch to FUE; that said recently the mean % has certainly moved towards FUE as the majority; I cannot tell you why and maybe simply the type of patient we attract at present; I have posted a great deal of FUE results in the last months. That does not obviously include those we advise against a procedure.

We do not agree to do more than 3000 FUE in one session, be it over two days we call that a session; so if someone was to need more than 3000 grafts we would not accept them for FUE anyway if we felt the result would be impaired in anyway. The cumulative wound healing of over 3000 extractions Dr Bisanga feels is not condusive to the best result. The majority of FUE we do is between 1500 and 2500 grafts and FUT generally 3500 grafts to safe donor maximum, 5000 etc

If someone comes in and doesn’t mind their donor being overharvested we would advise against it and give our reasons; but we would not be willing to compromise on our protocol and would strongly recommend they rethink their perception of hair transplant and donor management.

There has been much said about the yield of FUE being less than FUT, so if we play on a level field and assume that both are performed to a high standard. There is no reason why the yield should not be the same. There is talk about FUT giving more fullness in a result, and this is different from yield; dependent on hair characteristics someone’s’ maybe better suited to FUT, especially if their hair is fine. But in terms of yield and assuming the procedure has been done to the highest standard there should be little to no difference on a FUE to FUT match off.

Which technique requires more skill? I think in some ways that is an unfair question because a good h/t requires great skill regardless of technique; and in my opinion FUT & FUE are very different and require different skills. What is important regardless of technique is that your doctor and then to his staff have a real empathy for what they do and gain a sincere joy of creating a work of art, then regardless of technique a great hair transplant is created.

I appreciate that some say a two day FUE session is two procedures, well whatever pleases; it is one session. Dr Bisanga will perform generally 1500-1800 FUE in a day, with a scheduled 3000 FU procedure over two days. He does not believe in pushing the barrier and any FUE doc will appreciate that there are many variants in extraction that can slow a procedure down so there is no need to push the barrier to be “the fastest”; more important is the result in the long term.

OK, you say stabilised hair loss; how do you quantify that, I’ve had 30 year old say hair loss stops at 33, I’ve had 47 year old man NW3 “stabilised hair loss” and in 4 years he was a NW6; so you cannot assume hair loss is stabilised. Not wishing to not answer but I decline to on this one because there are too many variables and if I try to give a definitive answer it will start a debate that will never stop.

39

Thanks for the answers to interesting questons.

You say that results are compromised in FUE over 3000 because of the insult to the donor area. It seems you are bringing up a point never mentioned before; that there is a limtation that could result in depleton of follicles in the donor area in FUE be large sessions. Are you comfortable that ths does not happen at all with smaller sessions. Surely there cannot be a cuttoff where above 3000 there s suddenly a large ammount of damage.

40

» Thanks for the answers to interesting questons.
»
» You say that results are compromised in FUE over 3000 because of the
» insult to the donor area. It seems you are bringing up a point never
» mentioned before; that there is a limtation that could result in depleton
» of follicles in the donor area in FUE be large sessions. Are you
» comfortable that ths does not happen at all with smaller sessions. Surely
» there cannot be a cuttoff where above 3000 there s suddenly a large
» ammount of damage.

Hi marco,

Dr Bisanga believes to do many more than 3000 in “one Session” puts unnecessary strain on the donor certainly, but this is relative obviously to the donor in the first place, maybe doing many more than 2500 in some cases would not be recommended; healing, skin characteristics have to be taken into consideration. No different in a way to removing a strip with FUT, not everyone has the ability to reach say 5000 plus in one strip, be it poor laxity or donor density, without potential compromising the healing.

There will always be a depletion if FU when you start talking 3000 plus FU being removed because FUE is less forgiving on the donor in this respect, actually removing FU and creating less density or wider areas between each FU depending on the extraction pattern and the amount required. “Damage” can be termed as either medical, like scarring or poor healing to over harvesting; we have done a number of cases over 4500 FU over multiple sessions but not that many because basically you have to have very good density and hair characteristics to make it possible without over harvesting.

In respect of smaller FUE, one thing that people ask when say having 1500 FUE procedure is can we only shave a small area so they can hide it, rather like the strip idea. This can result in over harvesting a small amount in a concentrated area and is not advised. Even on small FUE the entire donor should be shaved and the donor area segmented into areas and then the correct extraction pattern used to make the harvested hair almost undetectable that it has gone and the density hardly effected because of the wide surface area. So, we are comfortable that this does not happen in smaller procedures. This again is all relative to whether you are a good candidate for FUE in the first place and that all avenues have been explored and that future loss and donor management has been examined as best as possible.