This Web site names thirty-four coalition doctors and recommends twenty-three more who are not "coalition members." This has me raise two questions:

1. What distinguishes a "coalition surgeon" from one who is simply "recommended"? The site mentions the former must have "demonstrated capability to successfully perform large sessions of ultra refined follicular unit grafting using tiny incisions and grafts that are microscopically prepared" and show "the ability to dense pack tiny follicular unit grafts in a given area when appropriate" (http://www.hairtransplantnetwork.com...physicians.asp). But, shouldn't any competent physician, in this age of the technique, be using "tiny incisions" and preparing grafts "microscopically"? I'm under the impression slicing up grafts using a simple magnifying glass is too primitive to allow one to be recommended.

2. Are those doctors who're constantly discussed in this forum measurably more reliable than those who are not? Of the thirty-four aforementioned surgeons, only a handful have a constant and potent presence in these threads. Dr. Feller comes instantly to mind. Should a potential patient, then, believe Feller's (not to pick on him) work or method is any superior to, say, Gabel's (not shilling, I promise ??” just an unfamiliar name picked randomly).

Thank you.

CuriousJungleGeorge,

I appreciate you asking this question, because it's an important one.

Surgeons recommended on the Hair Transplant Network and physician members of the Coalition of Independent Hair Restoration Physicians are both required to prepare grafts microscopically. This is listed as the number 1 criteria on our selection criteria page as follows:

"A demonstrated proficiency and commitment to performing high quality follicular unit hair transplantation using grafts that are microscopically prepared."

And while some surgeons recommended by the Hair Transplant Network do larger densely packed sessions when appropriate for the patient, this is only a requirement for Coalition members. Below I explain why.

While large densely packed sessions are highly popular for good reason and require great skill, experience, and staffing; this community is mostly interested in the end result, no matter how many procedures it takes to get there. This is indicated by our selection criteria that applies to both recommended and Coalition physicians. I've listed it below as follows:

"Excellent patient results demonstrating a high level of artistry and naturalness throughout, as well as excellent growth rates. "

Just as there's more than one way to skin a cat, there's more than one way to perform a quality hair transplant. While it's common knowledge that today's gold standard is follicular unit hair transplantation, using ultra refined skinny grafts verses slightly larger chubby grafts is still a hot topic of debate amongst leading hair restoration physicians. While creating the tiniest incision and using ultra skinny grafts enables physicians to densely pack more follicular units per square centimeter, data still supports higher growth yield with chubby grafts. By leaving more supportive tissue surrounding the graft, hairs in telogen are less likely to be cut (transected) and lost than with skinny grafting. Additionally, leaving extra supporting tissue surrounding the graft protects the follicle from harsher conditions such as drying out too soon or being easily damaged.

Additionally, while there's no doubt that it takes a highly experienced surgeon and large and experiened staff to perform large densely packed sessions, there are varying philosophies on how much tissue can be safely harvested while minimizing the risks of scarring. While some surgeons continue to push the envelope in harvesting more tissue, other surgeons are more conservative and would rather reduce the risks of bad scarring even further. On the other hand, there are those surgeons who would likely push the envelope but don't have the experienced or an adequate staff size to accomplish this (yet still produce excellent results in smaller sessions).

Physician members of the Coalition have proven to be able to perform these large densely packed sessions when appropriate for the patient with great success. And while some physicians recommended by the Hair Transplant Network can too, others vary in philosophy and/or don't have the experience and staff to do these larger sessions. However, all surgeons recommended on the Hair Transplant Network have a proven consistency in producing natural looking results with high growth yield and minimal scarring.

Due to the varying philophies and the gray areas of hair transplant surgery which include dense packing and session sizes, we believe surgeons who perform quality follicular unit hair transplant surgery with natural looking results and excellent growth yield have a place in our community.

Though the difference between recommended and Coalition surgeons isn't always cut and dry due to the varying abilities and philosophies defined above, those who have been approved for the Coalition have raised the bar of hair transplant surgery and have truly established an excellent reputation for being among the best in the world. That's why we typically recommend surgeons who meet our standards first. Then with time, as recommended surgeons establish this community's trust, those who are elligible (performing large densely packed sessions when appropriate for the patient) are considered and presented to this community for Coalition membership.

See also How We Recommend Hair Transplant Surgeons.

I hope this helps.

Bill

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Thanks, Bill, for your complete (and promptly delivered) reply. Based on what you've said ??” I hope you don't mind my saying ??” I feel the term "ultra refined follicular unit grafting" is a bit misleading, or at least unfair. From the information you've provided, it seems the alternative to this technique (i.e., using "chubby" instead of "skinny" grafts) is equally valid, and is simply preferred (for scientific, not financial, reasons) by some doctors. Until I read your post, I was under the impression "skinny" was better, based only on the term "ultra-refined" (which just sounds superior to anything it's up against).

CuriousGeorge,

Ultra refined follicular unit grafting is the procedure of choice for most patients and quality physicians. Physician members of our community who employ the method significantly reduce trauma to the scalp by making smaller minimally invasive incisions, produce excellent growth yields, and can often give patients the density they want in a single procedure. Losing a few hairs in telogen is well worth the price for many patients to get the results they desire in a single procedure. Thus, I think the term "ultra refined follicular unit grafting" is quite fitting.

If you haven't already, you may also want to read recommended physician Dr. Beehner's thoughts on Chubby verses Skinny Grafts. I feel this article provides a balanced overview of the pros and cons of using both types of grafts.

All the Best,

Bill

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.