Coalition Surgeons

M&M · #21 **Top** 09-26-2009, 07:48 PM

Bill,

I think you might be over-reacting to say that Severn is 'condemning' the majority of the coalition as a result of this one incident. All he said was:

"It's scary this is a coalition clinic"

I don't disagree. The lack of documentation, poor photography and questionable results is a little scary. They should know better and we deserve better.

He goes on to say "...there are probably only two, maybe three doctors ... that I would dare let touch my head."

This opinion has likely been based on several months or perhaps even years of watching the same top doctors put out top quality work, while others seem absent. Isn't this the reason that you and Pat are now mandating clinics to post at least a minimum number of cases online every month?

Nobody is questioning that you and Pat work hard to build up this forum, to add top doctors as either coalition or recommended. But let's remember what industry this is: Puig, Cleveland Hair Institute, Bosley, MHR, Armani, paid clients posing as 'anonymous' bystanders on blogs, etc. This industry is full of questionable tactics and I think Severn (and all members) have every right to question who touches their head and to equally share their feelings about it. Remember, you have removed a few surgeons from the recommended/coalition list in the past few years since I have been on here, so it is ultimately up to *us*, the patients, to decide who we would go to as *we* ultimately are held responsible with either a marginal, good or excellent result. Personally, when I factor in artistry, consistency, response to patient's concerns (if any arise), there are only a handful of coalition physicians I would trust my head to as well. There's nothing wrong with that. This site has helped to narrow down the best, and it's up to us the patient to decide who to go to, based upon our individual circumstances.

Finally, I find it disappointing that you are taking an aggressive stance against a patient who is looking into hair transplants and is admitting he is "nervous". He has every right to be nervous, given all that has disgraced this industry and the large number of 'butchered' hair transplant stories still coming forward now in 2009. I can't speak for Severn, but I'm quite certain he didn't mean this in a negative way but just to say openly that he is nervous. It would almost be naive to not be a little nervous.

I think it would be better to be more understanding of someone expressing his/her opinion, concerns, fears, etc.

Also, it might be prudent to start revisiting some of these top clinics to ensure that their original high standards are still being held intact. It's just a thought.

M&M

Severn · #22 **Top** 09-26-2009, 07:59 PM

Ha ha! Thanks for the defense M&M, but it's not needed. Bill had a good point. After I entered that post I realized it didn't convey what I was trying to express. It could easily be interpreted that I was disregarding the entire coaltion except 2 or 3 docs.

And if I had done the insane amount of work that Bill and Pat have done to provide us with this type of transparency, I think I might be vocal about it as well.

As I said, plenty of great docs in the Coalition. It's just a little natural fear kicking in of the "what if's". And I also realized I had mixed up the doctors. I misread the original post as Dr. Rahal instead of Rassman.

Bill - Managing Publisher · #23 **Top** 09-26-2009, 08:25 PM

Severn,

I appreciate the clarification in your thinking. I completely understand the anxiety you feel as your hair transplant procedure approaches. You certainly have the support of this community including mine.

M&M,

I made the reasons for my post to Severn clear. For you to say I've condemned him for admitting he is nervous about his upcoming procedure is highly inaccurate. The point of my post wasn't to dismiss his anxiety as he approaches his upcoming procedure. It was to challenge the implication that only 2 or 3 Coalition physicians are doing top notch work. Even Severn recognized why I needed to challenge his statement.

I am well aware of what the hair transplant industry is about, including many of the unfortunate and dirty behind the scene tactics and politics that don't even come into public view. Trust me when I say that Pat and I have fought many battles in order to preserve the integrity of this patient driven community and the credibility and reliability of our recommendations. Perhaps this is why I feel the need to challenge potentially false and damaging statements such as the implications Severn accidentally demonstrated.

As always, all physicians recommended by this community must continue to prove they meet our high standards in order to continue their recommendation status. This is why (as you well know), some physicians have been added over the years while others have been removed.

We review clinics regularly in various ways, including patient posted results, results presented on this forum by the clinic, and Pat's visits and observations of clinics in live surgery.

I do appreciate the input about revisiting clinics. Pat has visited with a number of clinics more than once and will continue to do so as part of our continued review process.

Thanks for the suggestion.

Bill

Bill - Managing Publisher · #24 **Top** 09-26-2009, 08:28 PM

Now back on topic...

Yesterday, I contacted Dr. Rassman and asked that he respond to the concerns of this community. I also suggested that in the future, that his clinic get in the habit of taking and presenting more realistic photos showing multiple angles (including postoperative pictures).

I heard back from Dr. Rassman today who briefly looked at the album and suspects the graft information was typed incorrectly. However, he has to confirm this when he's back in the office Tuesday after he looks at the patient's chart. I have encouraged him to reply to this topic with as much information as possible at his earliest convenience.

Best wishes,

Bill

hairthere · #25 **Top** 09-27-2009, 05:43 AM

That has to be a hair count and not a graft count...although that doesn't explain why the patient needed 4 surgeries to achieve it.

skunky · #26 **Top** 09-27-2009, 11:51 AM

This case just needs some clarification which I hope will be next Tuesday because I believe it may be a misleading post for those new people seeking to restore their hairline and seeing this case (so many grafts= so sparse density?).
4 Surgeries is just ridiculous or maybe the post op pics are from the first surgery?
Will keep my eyes on this one.

Dr. Bill Rassman · #27 **Top** 09-30-2009, 04:15 PM

The patient actually received 3790 grafts (sorry for the typo), 1350 in the first procedure and 1025 in the second. The patient lost some hair behind the original transplant. After the second procedure, the patient had a stretched scar measuring 1cm in width in its widest portion. The third and forth procedures were combination of two hair transplant procedures with scar revisions. The grafts were placed to thicken the work previously done. The entire scar was removed and closure tensions were low at both procedures and although some scar returned, the scar was improved.

All strip procedures produce scars. In some patients, the scars widen. I believe that the scars that stretch are more tied to the patient's healing characteristics than the surgical technique or the size of the strip. In this patient, there was no wound tension at the wound closure on any of his procedures, but scar revisions are less than a perfect process. I have not seen any patients where the scar revisions made the scars worse (although I heard of one patient who had a genetic collagen defect and had his scar widen when an attempt at repair was done). Most patients get some improvement from a scar repair, possibly because the strip is limited in width. Amongst physicians who perform strip surgery, there is no general agreement as to the proper scar repair technique. Many surgeons close the wounds with a single running skin suture, while others close the wound with a two layer closure to guarantee a lower wound tension. In the two layer closure, the deep layer can be closed with interrupted absorbable sutures, or they can be running sutures. I have been using a running quill suture for my scar repairs and the sutures are anchored in the occipitalis fascis (deep layer) which is imbricated to take up the tension at the closure. With these closures, the skin tension is often very low, yet the scar may still return despite the logical value of the deep layer.

Comments were made by some of the posters of my classification of this patient's balding pattern as a Norwood Class 3. I would rather consider it a 3A evolving into a 4A pattern. The nubbin of hair in the center on the original pictures was highly miniaturized. There was critical comment about the shape of this patient's hairline. I recommend on most of my Caucasian patients is what I discuss as the normal mature hairline as shown in: http://www.baldingblog.com/200...-mature-with-photos/ . The midline is measured one fingerbreadth above the highest crease of the wrinkled brow and the shape is convex. In many Asians, some people from the middle east and many Africans, the hairline is flat. The child's hairline is lower, located at the highest crease of the wrinkled brow and is concave in shape (look at your children if you do not believe me) as are women's hairlines.

hairthere · #28 **Top** 10-01-2009, 04:23 AM

thanks for clarifying dr. rassman. makes much more sense now...

aaron1234 · #29 **Top** 10-01-2009, 10:48 AM

Yes, that explanation certainly clarifies things. It would be great if you could continue to include that kind of detail in the initial post.

Bill - Managing Publisher · #30 **Top** 10-01-2009, 07:58 PM

Dr. Rassman,

Thanks for taking the time to reply to this thread. I've taken the liberty of modifying the original post with the corrected number of grafts. I also included your reply in the initial post so that those who view these photos in the future will have the correct information without having to read all the way through the thread.

I do agree with others that this kind of detail would be very helpful in the initial post moving forward. I also encourage you to post top down before and after photos and surgical pictures in the future.

Best wishes,

Bill

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