Dr. Epstein,
1. I believe the direction of natural hair growth is best determined when the hair is cut to stubble length, not when left long. When cut short the direction of the hair is exactly in line with its associated follicle. When left long the actual angle may easily be distorted depending on which way the hair is combed.

Other problems associated with leaving the hair long during HT is that it will always unnecessarily increase the overall surgery time and place more stress on all the tissues and anatomic structures involved. Finally, it taxes the doctor and staff far more than is necessary because the visual field is often totally obscured and must be constantly combed and manipulated to simply see the skin.

Leaving hair long during an HT is like trying to read a newspaper below a glass bowl of spaghetti with marinara sauce spread over it. An unnecessary hindrance.

2. Isn't it easier to simply outline the areas that need more attention with a surgical marker BEFORE surgery rather than to work in a tangle of blood-clumped hair?

3. There is no question that patients prefer having their own hairs so they are presentable. But at the expense of the final result which brought them to an HT clinic in the first place?

Dr. Mejia,
We do not use multi-bladed knives of any kind in our practice. In 2003 I asked Roy Ratson of Cutting Edge Surgical, Inc. to produce a multi-blade prototype for me. He built one out of aluminum stock and sent it to me which I used in a few cases. Personally, I found it was of little advantage when compared to my single blade holders and decided not to include it in my practice. I know he still sells the unit, but I know of no doctor who uses them regularly.

For what it's worth, the only application for which I asked Mr. Ratson to build such a tool was for areas of scalp on certain patients that were completely devoid of terminal hairs. It was never to be used in hair bearing areas of recipient scalp. I still have the prototype device which I will snap a picture of and post on this thread next week.


Also, as far as your patient Andy. You should understand that the amount of hair that would have to be cut in his case would be minimal. None of what is referred to as his "long hair" would be touched. The video clearly shows baldness and miniaturization of the frontal third of his scalp. Most of what would be cut there would be completely grown back in 3 months, not years. And the cosmetic difference would be negligible.

If you view the link below, you will see before/after pictures of a patient of mine who also had "rocker" long hair. I did not have to cut any of his cosmetically significant hair to achieve the look he and your patient Andy were after. Only the miniturized hairs in the target recipient area were shaved:

"Rocker" long hair paitent who didn't need to cut his long hair to pack the bald area in the front

Do you have any intraoperative photos of Andy or post operative photos? They would be helpful if you post them as we can compare them to the density offered by shaving hair down in the recipient area prior to surgery.

Perhaps you and Dr. Epstein are confusing the phrase "cutting or shaving hair" as meaning the ENTIRE head and not just the target areas?

I look forward to the Andy photos.

Best of luck,
Dr. Feller

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Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

Providing Hair Transplants and Platelet Rich Plasma (PRP) Treatments

Blood pressure is tip top - but glad you got that off your chest mate

Try keep on track

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

Edited to maintain the topic of the thread, which I missed..

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

Jason,
What Dr. Mejia is referring to is a handle for custom cut blades for making incisions. Not the multibladed scalpel for donor harvesting. Dr. Wong has presented the instrument at conferences and demonstrated it's use when he and Dr. Shapiro did a side by side demonstration of coronal vs sagital incisions at the live surgery workshop in San Diego in 2006.

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

wow... dr epstein.. i was not aware of this specific detail.. that you dont want to cut the hair short..
i like you attitude too..
here i see people talking abt
1) cost
2) distance to the clinics
3) shaving and not shaving recipient area..
4) others things i cant remember now..

but not many talks abt docs attitude..
you score there too..

"sales consultant" that was a good one...

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http://www.hairtransplantnetwork.com...asp?WebID=1247

Single Verses Multi Blade Tools to Make Incisions

In my opinion, a single bladed incision tool seems optimal in order to prevent native hair transection in the recipient area and to carefully and artistically create recipient incisions that will mimic nature. I can see how a multi-bladed instrument may be appropriately used in certain areas of the scalp where patients have no terminal hair, but I would be afraid that some artistry would be lost.

As a patient of Dr. Hasson's, a single bladed instrument was used to make all of my recipient sites. I believe this is their standard practice, but perhaps Joe can chime in here.

Shaving the Recipient Area

I'm hearing some say that it is easier to determine the natural angle of the hair when shaved, and other say it is easier when it is long. I would love to hear more detail on this. I am also under the impression that hair combed a certain way when longer could make it harder to determine the natural angle of the hair, so I'm highly interested to hear more detail about the opposite point of view.

Best wishes,

Bill

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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 Janna! Glad to see that we are not talking about the multi-bladed donor removal technique.

Although it would seem that a single blade would provide the best option for angulation and orientation, perhaps behind the hairline where "irregularity" is less of an issue and concise slit making is key, this would be a nice tool to use.

I guess for those who are bald and looking for a specific "coverage" density---say 35 fu's cm/2 behind the hairline over a 100cm bald spot, it will allow for almost even distribution?

Also, does the multi-site incision maker work in native hair?

Look forward to hearing more,
Jason

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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.

I just had my HT 2 days ago with Dr. Mohebi (I will post my experience and photos pretty soon) and I personally decided to have a very short haircut (almost shaved)on the recipient area to make it easier for the operation.
I am really glad to have done that because not only it made it much easier and quicker for Dr. Mohebi and his staff to perform the operation but also I could see clearly the recipient area and how each single hair was placed.
I think that also makes it much easier to maintain the new hair during the first week when it comes to washing, cleaning.

As Dr. Feller mentioned "Leaving hair long during an HT is like trying to read a newspaper below a glass bowl of spaghetti with marinara sauce spread over it. An unnecessary hindrance."

Bruce

You could also add staples and sutures to this arguement.

If I were a Dr, I would want every patient to have a shaved head and to use staples - it speeds the whole operation and makes it easier on the Dr and the Techs

As a patient - I want my hair left a little longer for cover up and sutures for comfort

I have seen great results on both sides of the spectrum

So my advice is to find a top Dr that can accommodate your needs and wants


PJ

PJ - I enjoyed your post because for people who are considering Hair Transplants or for people who are considering another Hair Transplant the shave/no shave and staple/suture topic is of much importance and interest.

Dr Feller - firstly I would like to announce immediately that I hear your are one of the best , if not the best at what you do.

However, I want to challenge you some with some very basic questions for the above reason (I am in the market for a HT or in the market for another HT).

1)The shave preference seems to obviously be easier on the DR and its staff. Is that the reason you prefer to shave or is the real reason that you believe its unnecessary stress on all the tissues and the structures involved? Can you further discuss this if your position is its unnecessary stress on the tissues and structure.

2) Staples seem to be easier on the DR due to the speed. Dr. Feller is it your position that you choose staples over sutures due to the speed or because of some other relevance. Please elaborate your experiences if you dont mind. If your answer involves a combination of reasons , please rate the percentage of importance to help emphasize the value associated for each reason.

3) If a patient wanted you to perform their HT, and they mandated that you do not shave due to their profession or desire to hide the HT, A) Would you do the procedure and B) Is it your opinion the patient would experience a different result (with you doing the work) if they didnt allow you to shave vs if you would have been able to shave?

Lastly - MN315 made a reference to DR. Epsteins "attitude" which I surely view as professional,respectful and positive.

However, I would like to add that I like your "attitude". You come off as confident, smart, sharp, driven and very knowledgable on what you do....and for me thats the type of "attitude" I want in choosing a DR to work on me. (of course, this is my individual preference)

Sorry for the long post, but interested in your response.