Punch Size

Skywalker

Dr Cole,
I visited you about a year ago in London for an evaluation. As I suspected my hair characteristics are very poor (below average density, thin black straight hair, white skin, Norwood 6+, limited body hair) and even though I am a virgin head you thought I could get maybe only 3000 grafts from my head donor area.
Despite all this I am still looking to get an HT for the following reasons:
1) Some hair is better than none!
2) I think very very short hair looks OK on me and I want to take advantage of what I think is a valid phenomenon - the 'Less is more illusion'.
3) I do have some body hair and I figure I might be able to supplement my head hair. You seem to be getting very good at Body Hair.

At the moment I keep my hair to a stubble (1mm in length) and would like to retain that option. My fear is the scarring with the 1mm punch (and associated loss of pigmentation). Your patient TomOmasta says he has scarring with the 1mm extractions and Dr Feller's patient Balloonman says the same thing. Now I know you do not have a good relationship with Balloonman but TomOmasta thinks very highly of you, they are the only guys I know cutting their hair really short after such work and they are both saying the same thing.

I am aware that using too small a punch may compromise yield, maybe there is no answer for my position, I don't know, I do know that my requirements make me a difficult customer Smile

BTW, I am not nearly as bothered about the scarring on my body, it is the head that is the real concern.

I look forward to hearing your current thoughts on the matter and thankyou for your time.

drcole

The question you must ask yourself is, Do you want results or do you want someone to sell you on an idea that does not produce good results. Take a look at the guys screaming about punch size. They have terrible results. Those individuals who use 0.75 mm size punches or smaller across the board have terrible results. The donor area looks great simply because you are not taking anything out, but the recipient area looks terrible because all you transplanted was a bunch of single hair grafts and a bunch of destoryed grafts. If you come to me, i deliver results. You don't hear guys complaining about their donor areas with me. you hear guys saying, "I got results". if you want a terrible transplant done with a 0.75mm punch, don't come to me. i am not interested in a sales and marketing game. i am interested in providing a high quality result. I individuallize each case. I do what is necessary to produce consistent results across the board. those who want to be sold blue sky and the promise of poor growth have no business in my clinic. i am not a salesman. i am a physician interested in quality. believe me there is a growing group of patients who come to me because they got terrible results from the slick sales groups who use nothing but 0.75 mm punches. after they've paid alot of money for a poor result, they come to me to do it right.

surgery is surgery. it is not always perfect, but in our hands it is as close to perfect as is humanly possible. you must decide, however whether you want hair or to be bald. if you want hair, you must have surgery. our procedure is the one that produces hair and the best result in the donor area without strip scars. if you wanted an undectable donor area and poor growth, why did you have a hair transplant in the first place? You cannot add shade to the front yard by taking trees from the back yard if you do not dig them up. if all you move is a shovel full of dirt, you will still have the shade in the back yard, one less scoop of dirt and no more shade in the front yard. this is what you are geting from these sales groups and inexperienced doctors who sell you nothing more than an idea and poor growth to go with it.

i see no increase in scarring from our instruments and procedure. what i see is more hair on top of the head.

We do not get into a discussion of punch size simply because it does not matter. we have evaluated the differences between the smallest and the largest size instruments we have and there is absolutely no difference in healing. When appropriate, we use a 0.75 mm punch. When not appropriate, we modify our technique. you must recognize that we have over 32 different options that can be modified an infinite number of ways. most clinics have one or two options and as a result they have very inconsistent result.

Skywalker

Dr Cole,
OK OK I didn't mean to offend you! I am just trying to work out what to do. I know you are exceptionally good otherwise I wouldn't have bothered to register and ask you the question:)

If you say this 0.75mm stuff doesn't work then I have to listen to that.
You and Woods are the only two that have produced consistent FUE results I like so far.

Last time I saw you the view was that I was too poor a candidate for surgery. The next time you advertise a London consultation I will come back and see if you think the situation has changed.

forhair

Skywalker,
It is ok...the post is ok. I personaly have seen woods donor sites and they are no different then ours. What Dr. Cole says make seance...He got the results, so he knows what he is doing...he is using different tools depends on the patient grafts...it is also makes sense. Believe me, there is no Doctor who seek for perfection and improvement like Dr. Cole, If there is a better way to do things he will travel to the end of the world to discover...just like he went to woods, There is no ego issue here.
Other clinics can promise you the moon, But they can't fool people for a long time...we know excactly what their doing...we see their patients with wonderful donor sites and with no growth...promising low price while their work quality and experience is very limited. Be aware...

Skywalker

forhair,
thanks for the post. I wasn't planning to upset him! You've got to admit for a customer it is pretty hard to know what is going on Smile

Skywalker

forhair,
thanks for the post. I wasn't planning to upset him! You've got to admit for a customer it is pretty hard to know what is going on Smile

FITLocks

A surgeon should not use a .75 for the sake of using one. The punch size should be customized to the target FU in the donor area much like a blade is cut to the size of the graft in the recipient site. The "shoe" must FIT - pun intended.

The patient you are talking about might have had a good result. The point is more about consistency.

Skywalker

Bukkaroo,
did you see Balloonmans pictures on Pat's site - the 400 fix to his HT in Florida. Take a look at picture 5/9. I find it difficult to believe they deliberately gave him a hairline at that low density. In my opinion either Balloonman has not waited long enough for growth or there was a yield problem.

Consistency right now is indeed the worry right now.

forhair

Beerman,
Excellent post!, i couldn't say it better...

drcole

It is very hard to states one's honest thoughts and opinions on a forum where so many individuals sponsor the forum's founder and editor. on this forum, we have no toes to step on so we can tell it the way we see it.

one of the things i've learned over the years is that there are many opinions and sometimes the other side's opinions are worth noting even if you do not agree completely with them.

scarring is not a big problem with FIT or FUE. most loss of color from the extraction site is one of two things. one is a reactive hypopigmentation where the bodies' autoimmune response attacks the melanocytes. the other is more common and is due to the bodies reduced blood flow to the region where the follicular unit was extracted. the body acts to conserve energy and heat. it will not send as much blood flow to the area if it no longer has a cluster of follicles in need of blood.

the problem with the smaller punches is that they leave hair behind. when you fractionate things, growth can be delayed a long time. i suspect that they are also removing the follicualr sheath in whole or in part. if you don't have all the ingredients, you cannot make a cake or at least you cannot make one that you or anyone else would want to eat.

what we've done is look at the reasons for FUE failure. this has been the cornerstone of our research the past year. one is a punch that fractionates or transects. the other is removal of the follicular sheath. the other is allowing these very delicate grafts to dry out.

we are not giving up one new methods that will allow smaller incisions, but we know that a single follicle and its sheath are 0.4 mm wide and a two hair follicular unit is 0.8 mm wide. you cannot fit an elephant through your kitchen door and you can't always fit a 0.8 mm structure into a 0.75 mm cylinder. some follicular units will fit into the punch and some will not. you must customize everything.

i have a new prototype for a tool to allow for smaller punches, but it is still a prototype. having said this, i do not see any advantage in scarring with smaller punches. if you remove the follicular unit you will have a gap. this is not going to change regardless of punch size. if you remove only part of the follicular unit, you will have poor growth and less gapping. you must decide which you want.

remember, i was the first one to use a 0.75mm punch. if the punch i introduced to the world worked consistently well in all cases, i'd still be using it in all case. instead, i do what is going to give you the best result. i taught dhi how to do fit and fue long before dr. jones showed them. they were very slow learners and their strip doctors did not want anything to do with it at that time. Dr. Zontos was not with their team at that time. it was only after dr. zontos joined their team that they began to get good extractions. he has great potential and well respected by Peter Mac. i'd love to see him join our Cyprus team. He did not have a great deal of hair transplant experience though when he started doing FUE. he is now in his second year of doing hair transplants and he is starting to see some of his own results. he has the capacity to learn from his results and correct his mistakes. i suspect he will eventually learn that most patients are not going to be happy unless they grow hair. if he joins our cyprus team, we will show him the best ways to achieve great results and welcome him with the respect he deserves.

in the interim, we will continue to modify our procedure so that the results meet ever increasing standards. we do not get angry when people question our motives. advances in science result only from those who ask questions. we want to be pushed. we want you to keep us thinking out of the box and striving for better results. thanks for the input.