# The Bald Truth Radio Show > The Bald Truth: Show Archives >  NeoGraft Hair Transplant Warning - Let The Buyer Beware!

## tbtadmin

Follicular unit extraction (FUE) has come a long way since it was first introduced through The Bald Truth to North America by Australian hair transplant pioneer Dr. Ray Woods.  Early adapters of the technique found it to be extremely labor-intensive when performed correctly, and limited by the number of grafts that can be safety [...]

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## Cappy

So let me get this straight. The Neo Graft is now gaining popularity, more and more surgeons are starting to implement this in there practice, and Dr Bauman now releases a public warning stating that results may range from mediocre to disastrous if the machine is used by the inexperienced?

Isn't there some type of training from the manufacture of this "tool" that can help surgeons achieve the desired results? Perhaps similar to the training a once inexperienced Dr Bauman received?

I don't get it.

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## hudson

Winston
Your comment makes no sense.  Do you think that the only training someone gets on the NeoGraft machine is to "punch some holes in a person's head and throw some hair in it?" Do you not think doctors who acquire the NeoGraft device are given training in creating a hairline or angling of grafts if they are new to hair transplantation? Do you think the NeoGraft company wants to allow doctors to use the NeoGraft machine on patients and have them do bad hair transplants?  I do not want to burst your bubble but the established hair restoration doctors want patients to believe that it takes years and a lot of experience to learn how to do a hair line or place grafts.  The truth is that this is truly not so. These are skills that can be learned quite easily and within a very reasonable amount of time depending on the natural abilities of the doctor. These natural abilities cannot be controlled by NeoGraft. That is why they offer ongoing training for doctors who need more time for learning or practicing. 

Furthermore, do you think doctors who acquire NeoGraft are not interested in learning to become proficient hair transplant doctors?  Your comment is an insult to both the NeoGraft people and the doctors who are purchasing the NeoGraft device because you are making implications that neither the company nor the doctors care about the patients enough to make certain the doctor gets adequate training. I think you and the rest of the writers on this site should stop using scare tactics on the public in order to dissuade them from going to doctors who have purchased the NeoGraft machine. It is obvious to everyone reading the articles on this site that some of the established hair restoration doctors are fearing the competition from the new doctors buying this device and this is the reason for the misleading warnings given on this site to "BEWARE of new doctors using NeoGraft". Dr. Bauman was once a Newbie himself and I am certain he did not post that on his website! So let other doctors make their way into this field, as is their right, and leave it to their trainers and their own integrity to know when they are sufficiently trained to begin doing transplant surgery, just as Dr. Bauman knew when he was ready to do his own first case.

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## Delphi

I viewed the interview last night and thought it was extremely well done and very balanced. I heard nothing negative about Neograft during the interview that I can recall. To me  the focus was on inexperienced doctors doing hair transplants. Whether they use the NeoGraft or if they are just bad at doing regular hair transplants, I think patients need to know. Good idea about the list of doctors who train the new doctors Winston! I wonder if well ever see that list?

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## Jeffrey Epstein, MD

Actually guys, Winston is quite correct-  hairline design is not something one learns over a 1 or 2 day course-  instead, it takes years and years to develop an ability to convert an aesthetic design into reality  and that is assuming the doctor even has an aesthetic design, something of which many doctors do not have much of an understanding.

It has been pretty clear, at least to most of us more experienced and in the "know", that it was the intent of the NeoGraft to be promoted to non-hair transplant specialists to get them to use the device.  Otherwise, there would simply not be anywhere near enough surgeons already performing hair transplants to spend the $60,000 or so to purchase the machine.  The NeoGraft offers essentially nothing to my practice, other than a potential marketing edge (if I chose to utilize that), as I certainly do not need to use a machine to harvest FUE grafts nor plant them, to do the work that I and my highly experienced team of assistants are already capable of performing to the very highest standards.

The "threat" that the NeoGraft device poses to experienced surgeons is quite minimal in my opinion, as I believe that the majority of prospective patients are wise enough to do their homework and realize that the aesthetics of hair transplantation cannot be duplicated by a machine, nor taught over a day or two course.  I would think that spending some time on this site would not question that wisdom.

Jeffrey Epstein, MD, FACS
Miami and NYC

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## Jeffrey Epstein, MD

Training can be sufficient if it is intended to train on the technique on how to use the maching to harvest grafts and then plant them, although I'm sure there is a learning curve.
What cannot be trained in just a week, or even months, is outstanding hairline design.  Even with my background in facial plastic surgery aesthetics and 16 years of performing these procedures, I am still developing new appreciations and approaches for hairline design, the single most important element in the hair transplant procedure.

Jeffrey Epstein, MD, FACS
Miami and NYC

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## Cappy

Okay now Im starting to understand this warning. All this time when I would read the word inexperienced I was thinking of a regular HT doc who had simply never used this tool. But now the consensus I'm getting is that the word inexperienced is being geared more towards a surgeon who has never even performed an HT and finds this machine/tool appealing due to its "ease of use.

Thanks for clearing it up guys.

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## blowmeup

Its not rocket science that the Neograft company is in it for the money, it just looks like the doctors dont want to buy their expensive machine and they have to sell it to doctors with less understanding of the marketplace. I guess if I was a doctor looking to grow my business and  knew nothing about hair transplants and a salesman called my office to explain how much money I can make if I buy his machine, I might bite :Smile:

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## hudson

*NeoGraft Warnings Are Misleading The Public*
       For more than a year after arriving in North America, the tactic of certain forums and experienced doctors was to denounce the capability of the NeoGraft machine through inaccurate conjectures, misleading information, and false conclusions that made it appear NeoGraft was committing follicular homicide. All this negative criticism about NeoGraft occurred without the experienced hair restoration doctors or forum members every seeing the NeoGraft machine used in a hair transplant procedure!  This was hardly a scientific method for diagnosing a device. 
       These aggressive tactics, based on totally false facts, had potential to harm the NeoGrafts image in the public domain, which was an irresponsible act on the part of the forums and the experienced doctors.  The worst part was that the public was being misled by experienced doctors and forum members about the capability of the NeoGraft  not a fair thing to do to your readers, since they look to the experienced  doctors and forums to give them researched, honest answers.  Generating answers based on false facts, as was done with the  NeoGraft device, was a further disservice to the readers, who may believe the false information dispensed by the forum and doctors and limit their choices based on those false facts.  Since most of the experienced doctors do not offer the FUE procedure for hair transplants, I will leave it to the readers conjecture and speculation as to why the NeoGraft was portrayed so negatively, based on no factual evidence or experience with the NeoGraft machine.  
       The real facts about the NeoGraft machine is that it has been demonstrated at numerous, live procedures to doctors (about 4-6 demonstrations a month), including the one at the ISHRS in April where over a hundred doctors attended. At these live procedures the NeoGraft machine has consistently shown that it is a highly proficient tool that allows the patient to have the latest, most advanced, and most beneficial type of hair transplant called FUE. (See the discussion on radio http://www.thebaldtruth.com/featured...-a-closer-look   ).  An FUE hair transplant, compared to a Strip hair transplant is much less invasive surgically as there is no cutting and stitching. With an FUE procedure the hair transplant can be done with greater speed, benefitting the patient and the doctor, there is considerably  less down time, much less pain, fewer complications such as cut veins or nerves, a tight scalp feeling,  or buried grafts.  With FUE there are no elliptical elongated scars as with the Strip method. Some FUE patients, not most, may experience some minor white dots where a follicle was removed, but these become not visible when the hair grows back and hair can be still cut short, unlike with many Strip procedures.  Winston, you may not want a machine made hair transplant, but it has many advantages over older manual methods. 
       Now that the experienced doctors and the forums are unable to denounce the ability and proficiency of the NeoGraft machine, the latest sensational and misleading forum headlines consist of unjustified warnings to the public to beware of new doctors purchasing the NeoGraft machine.  This is just another tactic to try and dissuade patients from using doctors who have acquired the NeoGraft  FUE machine, the latest and most advanced way of doing hair restoration .  If you look at the roster of doctors who are purchasing the NeoGraft device, you will notice that many of them are the most prestigious, well established, highly regarded leaders in their specialties of Plastic surgery, Dermatology, and Cosmetic surgery.  Many of these distinguished doctors have not yet let the public know about their NeoGraft acquisition (as they are busy training).  Many of them have done extremely complicated surgeries, compared to hair restoration procedures.  The majority of them are trained surgeons, whereas the majority of hair restoration doctors are not.  I would bet that all of them feel certain they can achieve the level of expertise required to do hair restoration, beginning with the training they receive with the NeoGraft companys arrangements.   I feel certain that with the reputation most of these doctors have, they will not attempt to begin doing hair restoration on their own, until they feel secure they can do it properly. 
        With those doctors that have the least experience, the NeoGraft Company has arranged things so that the doctor can take as much additional training as needed. Furthermore, the company recommends that all doctors take outside training at the established organizations and with mentors that offer hair transplant training.  So the public, once again, as with the hype about the NeoGraft machine itself, (now it is the doctors) has nothing to worry about.  Why go down that road in such a public, meant to harm way to your fellow doctors, with such sensational headlines, unless there is a concern that with more doctors offering hair transplants there will be more competition and one way to eliminate the competition is to warn the public that the doctors may not be trained or experienced?  There is a good chance that this kind of reporting pretty much gets registered in the publics mind that the NeoGraft doctors are not trained, even if they are.  I believe this was the intent and this is not fair to the doctors,  who already ,like Dr. Bauman are trained or intend to become proficient before working on patients on their own.  
       Since we are speaking about training, many experienced hair restoration doctors were not so well trained themselves, since there are no regulations what constitutes training for hair restoration. There are doctors who open up their hair restoration practices with as little training as a couple of weeks or months, with some up to a year, and they were once upon a time not so experienced also and no one put out warnings. Why not warn the public about the new doctors who are being mentored now to become Strip hair restoration doctors, since Strip surgery is a more serious procedure that FUE and is needs more training time than an FUE procedure with NeoGraft?  It is important to understand that the technology NeoGraft uses simplifies the FUE procedure so that doctors can become proficient in using this device in a much shorter amount of time than if the doctor was learning manual FUE or the Strip procedure. This is what technology does.  With the NeoGraft machine the procedure is not as dependent on the doctors skills as in manual FUE or the Strip procedure.  Doctors may not like to hear this but this is a fact. 
       Winston, you say you found the interview balanced.  The interview might have been balanced if the discussion was only about choosing between going to an experienced Strip hair restoration doctor or one that is not experienced. Everyone would agree it is preferable to go to an experienced doctor, hopefully one that also has innate ability to do good work. However, the live discussion between Spencer Kobren and Dr. Bauman about the importance of a doctors experience is not the discussion to be had with the NeoGraft device because the NeoGraft device extracts and implants follicles in an entirely different way than what happens with the Strip procedure and even differently than manual FUE procedures. With the Strip method, cutting and stitching of the scalp occurs along with dissection of follicles from the Strip.  Follcles are implanted with tweezers which can damage them, when they are pulled or pushed during extraction and implantation. With the NeoGraft FUE method, individual follicles are extracted and implanted with highly engineered tools that use air pressure. No hands or tweezers touch the follicles. 
        Because of the differences in hair transplant methods between Strip doctors, manual Fue doctors and the NeoGraft method, in the case of NeoGraft, all doctors, whether experienced hair transplant doctors or doctors who have never done hair restoration are Newbies when it comes to extracting and implanting with the NeoGraft machine, two of the most important and key procedures of any transplant.  Of course there is more to hair transplantation, such as placing of grafts and doing hairlines, but these are skills that can be mastered in a reasonable amount of time with practice.  As for the artistry of hairlines, this depends to a great deal upon the innate artistic talents of the doctor, something which training can only teach to a certain point. This is true of all medical procedures doctors learn.
       Winston, you state:  I have a feeling if you thought it was so great Dr. Epstein, that you would buy one and so would the rest of the IAHRS doctors. I mean if it would make your jobs easier and give better results, then why not?  This question has several answers. To my understanding, most hair restoration doctors do the Strip technique. They seem to be resistant to changing over to the more beneficial, less invasive, less painful and less complication prone FUE method, especially now that the NeoGraft simplifies the procedure.  Instead of becoming the leaders in FUE transplants and using their experience and skills, in offering patients who are candidates, this more benign, less complication prone procedure, they are issuing warnings to readers to beware of new doctors who have purchased the NeoGraft and who are offering this more advanced method of hair transplantion to their patients. 
 It is interesting that many of the doctors who are purchasing the NeoGraft device, could have become Strip Hair rRestoration surgeons,  (some were but gave it up) but chose not to include this procedure into their practice, even though it would have added income to their practice.  In fact many of these doctors told the NeoGraft company how many patients they referred to  Hair Restoration doctors, losing that income.  These doctors now however, understand and see the value of the NeoGraft machine, both to themselves and to their patients and are very excited by the machine.  This is why they have decided to add this device to their practice. Many tell us they will designate a doctor to the machine, who can become proficient in doing Hair Transplantation. One can only conjecture that the established Strip method doctors already have their practice established and it seems they feel why should they change the way they are doing things when they are happy with their practice, regardless of the fact that a NeoGraft FUE procedure is more beneficial for the patient who is a candidate for this kind of procedure
       On Kobrens post it was stated: that there needs to be a more honest approach [by the NeoGraft company] to the marketing of this device, and that there is a serious potential to cause harm if this machine is irresponsibly sold to entry-level hair transplant practitioners.  Furthermore the article continued to say: The implications of this business model are profound, and should not be taken lightly by anyone considering surgical hair restoration. These are very sensational, inaccurate and uncalled for statements.  It is comments like this that make it difficult Winston, to take it down a notch!  I do not know what implications of the NeoGraft business model are profound.  Do you mean selling machines to doctors who will train to become FUE hair transplant doctors, and over time gain experience and enter into the experienced category of doctors?  I do not see any profound outcomes with this.  This is what all doctors do. 
       And why is the NeoGraft Company deemed irresponsible if it sells to entry-level doctors if those doctors are going to be trained and become proficient before they begin doing hair restoration?  As I have already explained all doctors are entry level when learning to use a new device, whether that device is a heart machine, a laser device, a bone cutting device or any other device and selling them a device that they are going to train on is not irresponsible, it is the norm for how doctors acquire and learn to use devices. The medical regulatory bodies decide who is qualified to use these devices, not the manufacturer or distributor of the devices, so why is the NeoGraft company irresponsible if it attempts to sell the NeoGraft device to doctors that are not skilled on the device (no doctors are as I pointed out) but considered qualified by the medical regulatory bodies to get trained on a device?  
       And I am not clear about the honest approach statement. What do you mean by that?  I will say NeoGrafts  approach to selling this device is very open and transparent. We want doctors to see in person what NeoGraft does so we have several live demonstrations every month where doctors observe a live hair transplant.  This way doctors can assess for themselves what NeoGraft is capable of doing. I think our business model is very honest, and responsible in its transparency.  I do think this type of reporting needs to stop as many comments are inflammatory and not merited or earned.  There does not have to be a conflict between a company selling devices and that company having integrity, which NeoGraft has along with the people working with  NeoGraft, most of whom are long established in the medical device business with a solid reputaion. 
       In conclusion, I do agree that each patient has to do his or her research to find the best doctor. The best doctor is not always the most experienced one since a certain amount of talent is involved in everything one does.  Sometimes it may be important to find the best technique. The NeoGraft group, along with many doctors, believes that an FUE Hair Transplant with the NeoGraft device is the best, most beneficial procedure for patients today, but was more difficult to master in the past without the NeoGraft machine and so was not routinely offered except by a small number of doctors.  I believe every doctor has a right to add devices to their practice, as allowed by the Medical regulatory bodies, and other doctors should not dissuade patients from going to Newbie doctors because they were Newbie doctors themselves at one time.  I am not at liberty to give out names of people working with NeoGraft.  If you want to know about the NeoGraft training of doctors, you might try speaking with Dr. Bauman who can share hisexperiences with you if he chooses to do so.  It looks like his training on the NeoGraft was fine as he is achieving good outcomes, as are the other NeoGraft doctors, some still with assistance and others when ready out on their own.

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## hudson

The last sentence should read:
It looks like his training (Dr. Bauman's) on the NeoGraft was fine as he is achieving good outcomes, as are the other NeoGraft doctors, some still with assistance and others who are already out on their own.

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## Jeffrey Epstein, MD

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

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## hudson

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.

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## Winston

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.

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## Jeffrey Epstein, MD

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

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## blowmeup

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?

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## hudson

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,

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## hudson

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.

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## hudson

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.

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## Winston

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 :Smile: 

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.

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## Delphi

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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## Winston

Its unlikely that hudson will be on the show since he still has not identified himself. I do think hearing both sides of the debate is very valuable for anyone who is thinking about having an FUE hair transplant.

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## blowmeup

Any news on the interview?  Spencer if youre reading this can you let us know?

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## David Bays

Absolutely unbelievable.  It never ceases to amaze me that whenever a new aesthetic procedure arrives, so too do the critics, almost all of whom have NEVER used or even seen the new technology in question. Introduction: Hello everyone, my name is David Bays, Founder and Managing Partner for Omni Medical, one of the distributors of NeoGraft.  I have over 16 years of experience in the medical aesthetics business and have worked for and with some of the most well known companies in the world at the manager and executive level.  Let me just jump right in and say that whether I worked with NeoGraft or not, the posts and press releases recently issued...more specifically, the headlines that had the words WARNING and NEOGRAFT broadcasted everywhere were completely over the top, misleading and possibly libelous in my opinion.  Its one thing to start a "discussion" on a new technology and how it may or may not improve that particular field and it's quite another to launch what I consider an all out smear campaign.  Fact: Plastic & Cosmetic Surgeons would have short lived careers without the technology manufacturers that provide them with the innovative "tools" that "assist" them with their craft and help to ensure the highest levels of safety and quality procedural outcomes are achieved. Fact: ALL surgeons are introduced to new technology ALL the time.  I thought it went without saying that NO physician or surgeon is exempt when it comes to learning any new procedure or technique in it's entirety from experienced professionals whether they are veteran physicians, nurse trainers, company representatives or a combination of all of these options.  Manufacturers of new technology are obligated to provide options for education and training (both direct and indirect) otherwise that company will not be in business for very long.  Physicians, especially new ones who wish to expand their scope of practice (which most have every right to do) are even more obligated to ensure that they are properly trained in any procedure they carry out as they are bound by a "do no harm" code of ethics.  They are further incentivised to receive as much training as possible with the threat of malpractice lawsuits and/or license suspension.  This is common knowledge or at least I thought it was.  Apparently according to some, we need to start including this disclaimer in every single marketing piece. FYI, if a physician "chooses" not to seek out and take advantage of all training available and necessary to competently perform any procedure to the highest standards, then it's safe to say that they won't be a physician for very much longer.  I also thought it was common knowledge that it was a patient's obligation and responsibility to research any physician's background and experience before having them treat you.  The internet is great these days and gives us access to resources to help us determine if: "I should let this person work on my car," "should I hire this person to be my contractor," and even "should I choose this doctor to perform my hair transplantation procedure."  Fact: The new 4th generation, FDA approved NeoGraft is a TOOL that for "some" will offer both them and their patients increased benefits.  Just as with any aesthetic device both surgical and non-surgical, these benefits are often subjective.  "Do I use IPL, fractional erbium, microdermabration or medical grade skincare to treat my patient's pigmented lesions?" "Do I combine treatments?" "Is this patient even a candidate for this procedure and if not, do I have something else I can offer them?" "Have I been completely trained in all of these possible options?"  The bottom line is that if you feel that the new 4th generation NeoGraft isn't a tool that you or your patients will benefit from, then just say no thanks and be done with it.  There are and will continue to be plenty more physicians who will actually take the time to see the new NeoGraft in action and decide for themselves that this will indeed be a great addition to their practice.  A lot of physicians, some of whom are very well known and respected have already successfully added NeoGraft to their practice. I have no doubt that their patients are happy.  In conclusion, I can confirm without hesitation that NeoGraft, Omni Medical and all of the other representatives will continue to encourage physicians to discover the innovation and numerous benefits (both procedural and financial) the new, 4th generation, FDA approved NeoGraft has to offer.  We will conduct ourselves with the highest degree of integrity and professionalismand we are all committed to encouraging the positive advancement of the hair restoration industry.  Whether NeoGraft was here or not, there will always physicians who will consider expanding their scope of practice to include hair transplantation (strip and FUE.)  We will continue to encourage comprehensive and continuous education for all physicians at all skill levels.  I look forward to hopefully working together to achieve this common goal.

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## Winston

Thanks for your response Mr. Bays. It sounds a little like political spin to me, but what do I know? You make some interesting points that all lead back to what Spencer Kobren and Dr. Bauman and Dr. Epstein pointed out in the first place. That the Neograft is just a tool as you put it and its up to the doctor to get the training to do a good hair transplant.  So whats your gripe?

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## Winston

Mr. Bays,  I was curious about NeoGrafts FDA approval and wondered if you can show me where I can find that approval on the FDA website? I also thought that the FDA only cleared medical devices as a 510k clearance. Can you clarify this for us?
Thanks!

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## Don'tDoIt

Mr. Bays, I think that Winston is asking a reasonable question.  What sort of FDA approval does Neograft have?  Why haven't you answered Winston's question?

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