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London Consultations with Dr. Bisanga, May 2008
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FUE Punch Size & Donor Management (Hair Transplant)

posted by Peter Mac, 14.03.2008, 03:46
(edited by Peter Mac on 14.03.2008, 04:04)

Everyone,

Thank you for the praise for the graphics. I co-authored that report with Dr. Bisanga and prepared all of the slide graphics. It was my pleasure to assist a world class surgeon like Dr. Bisanga who has worked so hard in this industry to present valid research about hair transplantation. It's hard for me to believe it's been almost three years since this report was written.

I've noticed some comments about the 25% factor. Where does it come from and why is it used? I would like to give some background into this presentation. First, the goal of Dr. Bisanga's speech was to show that FUE and Strip should complement each other, not compete with each other.

I mapped my donor area using a grid on the back of my head. I then took hundreds of microscope photos of my scalp and I counted every follicle. Then I created a spreadsheet showing the maximum number of follicles that could be safely harvested from my head. I determined this number based on my existing hairline density (suffering from MPB), which I considered to be the minimum density one could have and pass for coverage. I superimposed the FUE circles onto this donor area photo to show that trying to take bigger hair FUE's can damage surrounding grafts. That's why the 25-30% rule exists. To get 50% of the hairs on my head would damage the surrounding grafts. I am assuming a very simplistic model for harvesting of course. The photo used here shows good density, but not exceptional.

» I don't buy it. 25% is a very low #. If that is all that you can harvest
» from the donor, then you are not doing it right IMO.
Well, the main goal of that speech was to show that FUE doesn't let you harvest more than strip. Giving FUE the benefit of every doubt I concluded, at least for my head, it was mathematically impossible for a doctor to harvest more grafts from FUE than from Strip on my scalp. At the time Dr. Bisanga wanted to give this presentation, many doctors were making outrageous claims that FUE "expanded" the donor area and allowed surgeons to harvest more grafts than Strip. This was marketing hype and this presentation proved it. A prominent FUE surgeon openly criticized this presentation afterwards, but refused to provide any evidence to refute my mathematical findings.

I will find another graphic to show why you can't take 50% of the grafts from an FUE donor area. It has a lot to do with the geometry of the donor area. It becomes a very risky venture to take more than 40% of the grafts from the donor area via FUE.

Dr. Armani has publicly claimed he can take 15,000 to 20,000 FUE grafts from a donor area. I find these claims to be outrageous. I have a documented study of my own scalp with hundreds of photos and pages of calculations to show it's not mathematically possible for anyone to harvest such a number on a scalp like mine. Yet, some surgeons continue to make outrageous claims without any evidence to back up their claims.

I applaud my esteemed colleague Dr. Bisanga for his pioneering work in FUE and his honesty and integrity in always presenting the truth.

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