Bad Experience with Dr. Couto and FUExpert

[Zizou88]

Please note that this review is not related to the result of the procedure, as it’s only been 2 weeks, it's too early to judge.

Pre-procedure

Initial Appointment with Dr. Couto
It took place one year after making the appointment. As I am located on the East Coast, the appointment was scheduled for about 4 am my time. The week of the appointment, I contacted FUExpert to ask how the appointment would be conducted: “Should I call, use Google Meet, Zoom, etc.?” They mentioned I just needed to provide my Skype username and they would call me through Skype, which I found odd. On the day of the call, I woke up at 3:30 am and called FUExpert to confirm I would be getting a call, which they confirmed. By 4:10 am, I called back FUExpert, and they said Dr. Couto would call me any time now. By 4:20 am, I had not received a call, so I called back. They told me the Dr. tried Skype, but it didn’t work, and he had already left. They asked me to wait until he returned. I asked them to call my cell phone, give me their Skype username, and I would call them. I was finally able to speak with the Dr. at about 5:30 am.

Two important things happened during the call:

1. During the call, the Dr. reviewed my pictures and estimated about 2,000 grafts for the hairline, temples, and to reinforce a bit behind the hairline. He mentioned that in a worst-case scenario, if it continues to worsen, it might go up to 2,500 grafts. He said we could plan for 2,500 for now and then review it on the day of the procedure.

It's important to know that before my appointment with Dr. Couto, I had consultations with Dr. Konior, Dr. Gho, Dr. Wong, and Dr. Bernstein, and their estimates were between 1,300 to 1,600 grafts (excluding the crown). I was okay with Dr. Couto's estimate of 2,000 grafts (2,500 if things got worse), as we could always revisit it on the day of the procedure.

2. I asked him what parts of the procedure he performs and what parts are done by his team, technicians, or other doctors. This was very important to me, as I wanted to ensure the chosen doctor had maximum supervision. He mentioned there is a technician who does the extraction, and he does the implantation. Based on his results and that he would do everything except the extraction, I chose him for the procedure.

We concluded the appointment with him saying his next availability would be the beginning of April 2024 (a year after the call). He mentioned that his team would reach out with the estimates to confirm the appointment.

After the call, I sent an email to his team, summarizing what was discussed and requesting the estimate. A few days later, I noticed the team still hadn’t sent it. I followed up, and by the time they provided the estimate (about a week after the call), the next available appointment was no longer the beginning of April but mid-May.

During the year between the call and the appointment, I tried PRP (HIGHLY recommend), which significantly helped my situation. While viewing FUExpert results and considering my own condition, I sent an email with updated photos and comparisons to their results, indicating I didn’t think my procedure would require more than 1,500 grafts based on other patients and FUExpert’s results. Still, they said to keep the initial plan and revisit the number of grafts needed on the day of the procedure.

Procedure

I went on the day of the procedure (day 1 of 2). Their new clinic is beautiful, and the staff is nice and amicable.

Before the procedure started, Esteban (the technician performing the extraction) came, and I asked him about the number of grafts. He mentioned, “Let’s extract 1,100 grafts today and then see after the Dr. reviews it.” The extraction went smoothly, and after the extraction, Dr. Couto came and drew the hairline. We agreed there was no need to do the temples or the crown, and we were just going to lower the hairline a bit and reinforce the back of the hairline.

During the implantation, Dr. Couto worked with another technician who seemed to be helping by pulling/pushing the skin while the Dr. did the implantation. After a while, Dr. Couto left to do another procedure and asked Dr. Torres (another doctor) to finalize the implantations with another nurse. I did not like this, as one of my key considerations in choosing a doctor was to know which parts of the procedure would be done by the Dr. and which parts by others. My expectations after the call were that he would do all the implantation. I don't think I would have picked him if I knew he does not do all the implantation.

This concern grew as the sensation during the procedure was completely different when Dr. Couto was doing it compared to Dr. Torres. The difference in sensation wasn’t much about the Dr. but rather the nurse assisting. When Dr. Couto was working, I felt the technician pulling and pushing the skin, which I didn’t feel anymore when Dr. Torres and the new nurse took over. It seemed the nurse assisting Dr. Torres was being trained, as another nurse was instructing her. At some point, the nurse even asked Dr. Torres, “Why is this happening?” which could have been about anything, but it made me very concerned. After the procedure ended on day 1, about 65%-75% of the work was done. I spoke with Dr. Torres, who confirmed, “Tomorrow, we will need fewer grafts as we completed a lot today.”

I asked Dr. Torres if Dr. Couto could review the work done after he left, but Dr. Torres mentioned Dr. Couto was in another procedure and wouldn’t be able to come.

Afterward, I spoke to the nurse and asked about the plan for the next day. Would Dr. Couto be there? Could he review the result? I wanted to understand who was doing what. She mentioned that Dr. Couto does the most sensitive part, which is the hairline, and Dr. Torres does the rest. I told her that I should have known this beforehand.

The next day, Dr. Couto came, heard my concerns, and explained that this is how they work and not to worry, assuring me everything was going well.

Before the extraction began, I asked Esteban if we were going to do less extraction today based on the work done yesterday. He confirmed it would be less than the first day (1,100 grafts), but didn’t specify the exact number, and I didn’t push for it. After the extraction, the rest of the procedure was the same as the first day, but this time Dr. Couto reviewed the final result before I left.

Before leaving, I asked how many grafts were used. They told me the front desk would have that information. I went to the front desk, and they said the person who had the info (Candi) was not there, but she would have it the next day.

Post Procedure

I went the next day for an initial review. After the review, I asked Candi about the graft count, and she said she would send it by email as she didn’t have it with her.

I returned two days later for the initial wash. I asked Dr. Couto, and he mentioned he didn’t have that information/record with him. Before leaving, I asked Candi again, and she still didn’t have it but promised to email it the next day. Two days later, I hadn’t received it and started feeling uneasy about the situation. It’s been a week since the procedure, and I still didn’t know how many grafts were used.

After calling them and asking for the information, they sent me a report stating they used:

• 2,503 grafts
• 5,858 hairs
• 2.34 ratio

I sent an email stating this was impossible. I told them I had a conversation with Estaban, who confirmed the first day's extraction was 1,100 grafts, and both Esteban and Dr. Torres had confirmed it would be less the second day. Additionally, the original estimate of 2,500 grafts included the temples and reinforcing the crown, which we did not do.

Dr. Couto called me and explained that sometimes he had to split grafts. For example, if he extracted one graft with 4 hairs, he might split it into 2 grafts of 2 hairs each and charge for 2 grafts instead of the single graft extracted.

I was shocked as I was never made aware of this, and all other doctors I spoke with confirmed they charged by the graft extracted. Additionally, I see their results of patients with around 2,500 grafts from FUExpert, and their procedures appear much larger than mine.

I asked the Dr. to send me a report detailing how many grafts were extracted. The next day, I sent an email to FUExpert about my conversation with Dr. Couto, requesting the extraction report and the photos they took, as I wanted to share them for comparison.

It's been a week since then, and they still have not replied to my email. To be honest, throughout the procedure and process, there has been a lack of transparency. I do not know if it’s normal not to have this information two weeks after the procedure. The lack of transparency, communication, and comparison with other cases leads me to believe that their billing is not correct.

Would love to hear from people with more knowledge on the industry if this is normal.
*If I get the pictures they took will update the post with it, as they one I have is not great

 

Edited June 1 by Zizou88
eliminating a fixing a picture

[Ccd99]

Sorry to hear about your experience, particularly about Dr Couto who is generally regarded as a top surgeon.

I did not realise he does multiple procedures and does not cover all aspects of the surgery, that is a bit of a shock to me!

With respect to your procedure, 2500 grafts seem very excessive for the area covered. Difficult to say but based on your photo it look more like 1600-1800 grafts.

Hope you get an explanation from the clinic.

Edited June 1 by Ccd99

[asterix0]

Interesting you even went for a hair transplant at all, you have excellent hair.

Nevertheless, this was disappointing by the doctor and the clinic, you certainly have a case to be frustrated as it appears you were bait and switched.

[DermMD]

I agree with the above responses.  I find this to be unfitting of someone who is recommended and spoke about in the same class as some of the top tier surgeons. Being informed that a different person would be completing the work I was told would be by the surgeon I choose to do the actual job,  is unacceptable. Even if the results come out great, I would request my money back, and report this. As a physician, I find this deeply troubling. And I will say this, I hope there is no censorship of this post. 

[Gokuhairline]

you had perfect head of hair before , max 1,500-1,800 would have been fine.......either way i think it will come out great, welcome to norwood -1

[Jackdaniels]

I’m sorry to hear about your bad experience with dr couto.
I think it’s totally unacceptable to pay so much money for a surgeon who does multiple surgeries per day and he doesn’t even do the implantation by himself but he uses another doctor to do it. You paid for dr couto doing the whole implantation but he did only the front line. This is red flag 🚩 I think you should ask half of your money back because he didnt do what you paid for.

Also it’s unethical to charge the patient 2 times for a graft which is splitted into 2 grafts. An ethical clinic charges the patient based on the number of grafts extracted, and it doesn’t split the grafts to charge the patient more money.  This is another red flag from dr couto 🚩 

Edited June 1 by Jackdaniels

[GeneralNorwood]

Couto is one of the best in the industry, that's why you went to him in the first place. 

 

But this shady tactic to change surgeon who is doing implantation, it's low standard. Obviously he wants to expand, so he is doing multiple surgeries and hiring new surgeons. But even Eugenix is transparent about that, who will be doing implantations. 

 

So, dr Couto, you can do better!

 

PS. Charging per implanted grafts(including splits), not extracted grafts, it's pretty standard in the industry. 

[GoliGoliGoli]

1 hour ago, GeneralNorwood said:

 

PS. Charging per implanted grafts(including splits), not extracted grafts, it's pretty standard in the industry. 

I understand splitting a graft into a single for use in the hairline, but what would be the purpose of splitting a 4 graft into a 2 as the clinic used as an example? 

[salsazio]

Unbelievable 

couto is going to be a hair mills 

[RTC]

That graft splitting fee is 100% a money gouge.. they should be charging by grafts extracted only

Edited June 2 by RTC

[Electric]

People rely that the approved Doctors on this site will be top notch. They may so get so much business from being a " a forum recommended surgeon", that they don't try hard to do a great job any longer and become greedy.

I think that with a bad review such as this, The site should consider removing the Doctor from the preferred list. The next Doctor will think twice before taking poor care of one of the members on this site.

[Rawkerboi]

52 minutes ago, Electric said:

People rely that the approved Doctors on this site will be top notch. They may so get so much business from being a " a forum recommended surgeon", that they don't try hard to do a great job any longer and become greedy.

I think that with a bad review such as this, The site should consider removing the Doctor from the preferred list. The next Doctor will think twice before taking poor care of one of the members on this site.

Just look at Dr. Zarev focus entirely on one patient at a time, it's partly why his waiting list is very big. The guy treats Hair Transplants with the same seriousness as open heart surgery.

Dr. Zarev is 20 years ahead of the next best surgeon, it's absolutely nuts.

[salsazio]

5 minutes ago, Rawkerboi said:

Basta guardare il dottor Zarev concentrarsi interamente su un paziente alla volta, in parte è per questo che la sua lista d'attesa è molto lunga. Il ragazzo tratta i trapianti di capelli con la stessa serietà della chirurgia a cuore aperto.

Il dottor Zarev è 20 anni avanti rispetto al prossimo miglior chirurgo, è assolutamente pazzesco.

9€/graft

900€ consultation 

2027

[Electric]

Some people save for years, borrow..... and it's severely emotionally traumatizing to be damaged from the surgery. Any surgeon should treat their surgery as if it's life threatening. It's lack of integrity to turn into a mill for money. They need to be off the list when and if this occurs in my opinion. 

[davidn]

That whole industry is such a Joke. 

[BaldReaper]

Sounds like the time has come for Couto to go the hair mill way

[Melvin- Admin]

Graft splitting happens all the time, sometimes clinics will combine grafts singles into multiples. In those cases, they will charge per graft, even if they combine them. However, splitting a quad into two, and charging separately isn’t normally done.

I’m surprised given Dr. Couto’s excellent results and reputation. It seems like you just had surgery. It’s possible you end up with an amazing result. That may change your perspective on the surgery. Though, some of these concerns need to be addressed. 

Im reaching out to Dr. Couto for his response. Please allow him to post about your case here publicly. Please know, there will be no personal information divulged. 

[Maorizio]

Even though it’s annoying to hear such thing, I am pretty sure Couto hire and train the best of the best.

And as long as the hairline is done by him, which is the most important thing, I don’t see any chance for bad result.

But I do agree that the very least is to notify patients that it’s going to be like that and then we decide if to go for it.

[Konsole93]

Now I know why the area behind the hairlines from couto Look like its implanting in "rows"... 

 

[Eli_Avdikian]

Dr. Couto is an amazing surgeon. Definitely one of the best in the entire world. Nevertheless, everything that OP mentionned in this thread raises concerns, from graft splitting, to working on several patients a day, not to mention, delegating extractions and some of the implantations to someone else. Of course every clinic is free to adapt its own practices, but doctors are ethically obliged to share this kind of crucial information with their patients right from the get go. I especially find the practice of charging per implanted (and not extracted) graft highly unethical and problematic to say the least, and it is unfortunately reminiscent of some of the worst turkish hair mills. I myself have been a victim of this practice at the hand of a "reputable surgeon", but that's another story. 

Edited June 2 by Eli_Avdikian

[GeneralNorwood]

15 hours ago, GoliGoliGoli said:

I understand splitting a graft into a single for use in the hairline, but what would be the purpose of splitting a 4 graft into a 2 as the clinic used as an example? 

Yeah, that's propably a cash grab

[davidn]

3 minutes ago, GeneralNorwood said:

Yeah, that's propably a cash grab

Maybe thats how zarev gets 13k out of the donor 

[davidn]

Deleted 

Edited June 2 by davidn
Bad Joke

[GoliGoliGoli]

5 hours ago, Melvin- Admin said:

Graft splitting happens all the time, sometimes clinics will combine grafts singles into multiples. In those cases, they will charge per graft, even if they combine them. However, splitting a quad into two, and charging separately isn’t normally done.

What would be the purpose of combining some singles into a multi? I guess it reduces the amount of incisions needed? What does that process look like also, I would be worried you would somehow damage the graft during combination? 

[GeneralNorwood]

3 hours ago, davidn said:

Maybe thats how zarev gets 13k out of the donor 

Nah, it's not the case : https://youtu.be/XASvPhbsRO4?t=208

Recipient area for Norwood 7 is just too big and it requires 12 k grafts or more. When recipient area is 280cm2, you can't gimmick it with splits covering all the scalp. 

 

Quadruple grafts are usually less then 10% of the donor, so even by splitting them like apparently Couto does, you won't get much more "fake" grafts.