Coalition Surgeons

Bill - Managing Publisher · #1 **Top** 01-17-2007, 08:17 PM

Hello everyone,

I thought I'd move this topic here since it was being discussed in an unrelated thread. Please post all opinions and replies here:

What has been said so far:

Quote:

Originally posted by Mrjb:
" Could that be partially due to shaving the area? I can't say for sure...but I would guess that incisions are easier to make when other recipient hair is not in the way, so I would venture a guess to say yes".

Good discussion

Easier does not translate to better. The point is; in my view, everyone has their opinion. Now, basing your argument on this i.e. " The best" is still an opinion.. If you say H & W is the best because he shaves the receip area that's implying all other doctors are not good by doing otherwise.. Also, Mega sessions i.e 5000-7000 graft HT's in my opinion are a bit dangerous.. With a limited donor area, what happens if 5 years down the road you have more loss and no more or little donor area.. You might end up with problems.. Guys, you can argue either way but personally, i prefer a more conservative approach. That's my opinion but I certainly respect each credible doctors preference and style ..

Quote:

Originally posted by Bill:
MrJb,

I agree good discussion...and I agree with you. I hope I didn't portray my argument as stating that shaving area = the best. All I meant to state is Dr. Hasson makes a compelling argument as to why it's beneficial. I think it's better to make things easier on the doctor to minimize risk. I think most doctors would argue that shaving would make it easier for them, but many don't require it. I believe we are on the same page here...

Regarding a more liberal or conservative approach...I don't think there is really any argument to proove what's "best" or not...it's just a preference. I would argue that a 5000-7000 session isn't dangerous if done ethically and correctly. Though I would agree that it CAN be dangerous like in a case where a 20 year old want to densely pack 4000 FUs into the hairline to achieve max density when his hairloss is so unpredictable. But 7000 FU megasessions on a NW5 for example who is 35 years old seems like a better (better is not factual, only opinion) option to me than doing 2 or 3 smaller sessions.

But yes, I agree...even those who are more conservative as long as they are yielding and producing excellent results, it doesn't take away from their credibility. After all...the Proof is in the pudding right?

Bill

Quote:

Originally posted by the B spot:
Shaving the recipient area is the BEST method for transplantation----- regardless of session size.

This is not to say that tremendous results cannot be achieved without shaving down, or that shaving down is the only way, but by and large I think most Docs and ESPECIALLY the surgical staff will agree that continual manipulation of the existing hair takes much longer and can create more shockloss.

In addition, the scalp looks much different under magnification, so when the recipient site is shaved it allows a Doc to reduce the risk of transection and work comfortably.

I don't know about you guys, but I want everything associated with my HT to easy and comfortable.

mrjb makes very valid points in regard to risk factors just as his argument about shaving down. Increased sessions sizes increase potential risk factors for complications......
ie-- If I hammer 3000 nails or 7000 nails, the greater risk of smashing my thumb occurs when I swing the hammer an additional 4000 times.
At this point, patient selectivity becomes paramount and for the Docs that are taking the Pepsi challenge for larger sessions, I think they are doing a better job qualifying patients in order to minimize risk.
Good Topic!

The fact of the matter is--- I know NOT shaving down can reduce session size, increase chances for transection, and increase potential for shockloss exponentially-------- IMO a better than logical argument for biting the bullent and pulling out the clippers!!!!!!

Great Topic Guys!!!!

NervousNelly · #2 **Top** 01-17-2007, 08:25 PM

I don't know how anyone can argue that it is not better. We can try to convince ourselves otherwise.

Like myself, I don't think that I can shave my head with my profession unless I can find a way to take 1 month off. I realize that it is best for both the surgeon and myself but what is a guy to do?? I guess I could shave and go to work and possibly scare the shit out of everyone if I wanted to but not sure I'm ready for that. This is the last piece of the puzzle for myself in planning everything. Bottom line--I think its best but can I swing it??

MrJobi · #3 **Top** 01-18-2007, 10:25 AM

NN

I'm in your boat too. I can't shave my head.. Now , keep in mind i've had 2 awesome HT's with Dr. True and was not required to shave my head (along with 90% of the coalition dr.'s...) Again, just beacuse it might make it easier to transplant does not mean it yeilds a better result.. These are two totally different thought processes. Ever thought it may just take a little more work and attention to detail for the doctor while transplanting? They have the micro-lenses and can clearly see the hair follicle . If it is markedly better why don't the majority of coalition docs require it? If it did produce a better result I'm sure they would request it as well. This is H & W's personal style. Some might argue H & W cuts their donor area rather high on the back of the head? Again, this is an opinion and other doctors might do it lower...Some say FUE is better than FUT. Does this mean all FUT docs are no good? At the end of the day it is wrong to discredit many great docs that don't specifically adhere to professional preferences of other docs (assuming they are using the most advanced FUT technologies).. This is true with other areas of medicine as well.. The proof is in the end result.. I have had 2 HT's with awesome results and a scar which is undetectable down to guard 2 ( never gone shorter).. Lastly, we must also take into consideration what the patient needs. I cant shave my head so guess what.. It's not a better method for me.

nobuzz4me · #4 **Top** 01-18-2007, 10:45 AM

Mrjb and NN,

As you can see by my screen name, I would not go to any Doctor who requires you to shave down.

I am one week post op and it was no problem. They can still see the direction/angles of hairs and work between them. It is probably a little harder for the doctor and the techs who insert grafts but that is what they are paid for.

I do not have real long hair but it is long enough that my scar is undetectable and my recipient area is almost undetectable. It is a choice IMO of the doctor just as some might prefer staples over sutures. Either way can give you a good result. The argument about dense packing does not apply to many who would opt for a little more coverage for a little less density. Unless you have endless donor, which most do not, it is not really worth argueing about.

There are just too many great doctors out there who do not require it.

the B spot · #5 **Top** 01-18-2007, 10:49 AM

JB--- no one is saying that tremendous results cannot be achieved by NOT shaving down, or that a dramatic difference exists between those who shave and those who don't.......

What I am saying is that shaving the recipient area provides the most OPTIMAL setting for performing a HT, that's all.

I think if you ask the Docs that don't "require shaving" that when push comes to shove, on larger sessions both Doc and Staff would prefer shaving the recipient area.

I think 1500 grafts or an exposed hairline/temple region would not require shaving, but that is my opinion only.

Anyway, for people like yourself or NN who simply cannot shave down, there is really no debate because the circumstances simply do not apply.

My statement is in regards to the optimal setting only.

Again, Great Discussion...........

MrJobi · #6 **Top** 01-18-2007, 10:52 AM

Thanks Nobuzz

I would love to hear from some Coalition docs on this point other than H & W who has already stated their good case..Feller, True,Shapiro, Rose,any other to chime in. Nice to hear what the other 90% have to say to this point

???

Bill - Managing Publisher · #7 **Top** 01-18-2007, 11:45 AM

Quote:

Again, just beacuse it might make it easier to transplant does not mean it yeilds a better result..

This is a sticky statement...it's partly true and partly false. You are right...making things easier for the doc does not necessarily mean you WILL get a better result, but it MIGHT. Consider anything you do well. Let's take martial arts as an example (why...because I studied and took it for a long time and I can relate to it). Under what conditions could you perform the best? Under which conditions would it be more difficult for you to perform? Let's consider some variables in this example:

1. Mental or physical stressors (muscle tightness, tiredness, emotional issues, sickness)
2. Environment (atmosphere, lighting, spectators, judges)

Under which conditions could you perform the best? Chances are you perform better well rested, and the less emotional or physical issues, the better. Environment may be a personal choice as to what you like. We'll call any condition that may hinder your best performance "stressors".

Since surgery is not an exact science and is more of an art...why create unnecessary stressors for the doctor if they can be avoided? It's not that the doctor still can't perform his/her best...but why make it more difficult? Any added "stressors" have the POTENTIAL to hinder perfromance. This is a true statement no matter how anyone looks at it. I use the word potential here to show that it's not inevitable that one way will ALWAYS produce a better result than the other...but there are definite considerations why shaving your head is the BETTER option.

But again,

Many physicians have still proven, even without shaving the head, that they can still yield a superior result. BUT, I bet many of those same physicians would admit that shaving of the head would make make it easier, thus reducing a stressor.

Bill

NervousNelly · #8 **Top** 01-18-2007, 03:48 PM

Well stated Bill. I can't add to that.

MrJobi · #9 **Top** 01-19-2007, 04:09 AM

Thats a good point Bill

However, we can use this resonsing for a doctor performing a mega session as well. Placing 6000 HT's or more in a 11 hour day is quite a task. If we were to look at a graph of performance you would see as work time increases performance decreases. You can see this is sports especially. So could we also say you Might get a better result if you break it into 2 sessions of 3000 to avoid fatigue??? In addition, the docs tech or one who places the hairs in the holes also has to cut them so we are dealing with eye and hand performance.. So all the advantages you may get with shaving may be a wash due to fatigue...

I'd love to hear from a professional on all topics we taked about..

thanks for the mental jousting

Bill - Managing Publisher · #10 **Top** 01-19-2007, 07:25 AM

Mrjb,

Good point. Yes, adding more work does mean the possibility that an additional stressor could potentially be added "fatigue". Typically to help avoid fatigue, however, clinics have multiple techs doing multiple tasks. The only real added work that could cause additional fatigue would be making extra incisions ex: 3000 verses 6000. But yes, there is additional and longer concentration needed to do larger surgeries which is another reason why it's important to choose a doctor who has proven themselves to be effective. And it's the same thing with shaving verses non-shaving.

Good discussion.

Bill

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