Dr Shapiro,

Just curious....are you currently, or planning to in the future, incorporating the new closure methods?

Awesome to see both Shapiro and Hasson on the boards!

Dr. Shapiro,

Great to see you participating on the boards. Dr. Hasson is out of town at the moment but I'll be sure to point our your questions so he can respond when he returns.

__________________
I am employed by Hasson & Wong as a patient educator. My opinions are my own and might not be that of Dr. Hasson & Dr. Wong.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

J-69, Dr. Shapiro has been using a variation of the "Frechet"/Trico method, which of course is the closure method that allows hair to grow through the scar itself, in essence creating a "scarless" HT. How do I know this you ask? Because I had this method used on me!!!!!! Since I have to have all of the information possible about everything, this closure technique interested me greatly (as it does all of us!). Dr. Shapiro's associate Dr. Rose is also quite well known for the LEDGE closure method as well.

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

b-spot......how does your scar look, and how is your scalp elasticity?

thanx man

Looks great for only 4.5 months. Still a little pink, but that's normal. Keep getting the bumps from hairs pushing through the scar itself. As far as scalp elasticty, I do the Jotronics prescribed scalp exercises daily so my scalp is pretty loose. You have to understand that my strip was only 1.25 cm wide (although it was 27 cm long). That is not a wide strip at all, so I was in no danger of tightness. I think I might ask for a bump up to 1.4 or 1.5 this time in order to yield well over 3000 for #2.

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

thanx B....I never heard Jotronics prescription....what is it and how fast can one expect to yield results? Im going in for #2 in a lil over a month...shooting for 3000 more..

Go to http://www.hairtransplantmentor.com/
and click on scalp exercises----- They really seem to work for me, so I highly recommend them, especially if you are doing #2...

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

B,

You might want to lighten up on those exercises for a while. I don't want you doing them vigorously until six months post-op from HT #1. Let the donor area heal my friend then get busy.

__________________
I am employed by Hasson & Wong as a patient educator. My opinions are my own and might not be that of Dr. Hasson & Dr. Wong.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

Absolutely Joe! Mine are more of a "head rub" at this point, and I will gradually increase them as time goes on. Thanx for the warning

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

Ron,

Sorry for the delay but I just got back into the clinic recently.

-Regarding the patient dependent factors for harvesting 4000 plus fu sessions.

Firstly, I am surprised that a 25 x 1.0 strip usually yields 2500 FU in your experience. It is my experience that the average donor density is in fact less than 100 fu per cm2. The reason for this is that the FU density usually falls off progressively as one moves from the occipital to parietal and temporal scalp. There is often a 15% to 20% loss of density between these areas. My average strips for larger sessions vary between 30 cm and 34 cm in length extending anteriorly on both sides to above and in some cases in front of the anterior border of the ear. Perhaps because I am utilizing more temporal scalp for donor this is reducing my average yield per cm2. For most patients it is possible to harvest a 30 cm by 1.5 cm to 1.8cm strip to yield approximately 4000 grafts. For sessions that exceed 4000 fu a patient will need both greater than average density and laxity. It is not that uncommon for me to harvest strips reaching 2.5 cm in width. The secret here is that the strip width is not kept constant for it's entire length. I divide each side of the strip into three separate sections corresponding to the different tensions along each side of the strip. The widest sections of the strip on each side are above the ear and posteriorly. Scalp has most tension in the area directly above the mastoid prominence on each side. Correspondingly I will taper the strip by as much as 30% or 40% in these areas. In this way I am able to close the wound with uniform tension throughout the length of the strip. Maintaining a uniform tension over the entire length of the strip is very important as increased tension above the mastoids will reduce the tensions in neighboring areas and the majority of the scalp tension will be borne in the areas of the wound above the mastoid resulting in wide or stretched scars.

-For those sessions which exceed 5000 fu.

In addition to high density and laxity the patient will often have a larger than average head enabling up to 4 or 5 centimeters in additional length for the strip.

As you are aware it is absolutely essential to maintain optimum conditions for graft storage and handling when performing these larger sessions. For this reason we do not recommend that clinics rush into these large megasessions. It has taken me approximately four years with an experienced team of twelve to fifteen surgical technicians to get to the level where I can confidently perform surgeries of 6000 or 7000 fu's. The more often you perform these megasessions the easier they become. We perform sessions of 4000 fu on an almost daily basis and have performed hundreds of these size surgeries. Contrary to what other physicians may claim the yields from these surgeries are every bit as high as when we were performing 2000 fu sessions several years ago. The impact of these larger sessions on the patients is far greater and I believe the reduction in number of surgical procedures that a given patient needs to undergo are quite obvious.

Ron, I honestly believe that the combination of these megasessions with densely packed fu's placed in lateral slit incisions is the way of the future. For me, it is really gratifying when a physician of your reputation starts to adopt techniques that we have pioneered. I hope that patients find this explanation useful in their hair transplant research.

Victor