Coalition Surgeons

Bill - Managing Publisher · #1 **Top** 05-12-2011, 01:17 AM

Dear Forum Members,

As many of you know, we gather as much information as possible about a physician, their staff, technique and track record before they are even considered for recommendation on the Hair Transplant Network. Part of our review process involves getting input from patients and the members of this forum community. To learn more about this review process, click here.

I would appreciate this community’s input on the potential recommendation of Dr. Carlos Wesley of New York on the Hair Transplant Network.

Dr. Wesley trained under Dr. Walter Unger and has been performing high quality follicular unit hair transplantation at his clinic in New York exclusively for over 4 years. He and his full time staff of 6 nurses and technicians averaging 7 years of experience have the skill and ability to perform up to 2500 follicular unit grafts in a single session when appropriate for the patient. Dr. Wesley operates on only one patient per day in order to provide his patients with maximum attention and the best results.

Dr. Wesley takes a conservative approach and believes in providing patients with what they need and not necessarily what they want. While performing all the initial consultations himself, Dr. Wesley stresses the importance of clear and realistic expectations established between the physician and the patient. Coupled with his state of the art technique, Dr. Wesley believes that a thorough analysis of the patient’s hair characteristics as well as an accurate understanding of their objectives makes for healthy and realistic expectations and a satisfying end result for his patients.

Dr. Wesley designs the entire recipient area and clearly communicates the placement pattern to the planting staff specifying where type of graft should be placed. All follicular units are dissected and trimmed under microscopes and then carefully placed into tiny recipient sites by his experienced staff.

After marking the desired strip with a surgical marker, Dr. Wesley uses a single blade exclusively to harvest the donor strip. Dr. Wesley believes that using a single blade allows for maximum control and minimal follicle transection. Dr. Wesley primarily employs the trichophytic donor closure technique using a continuous single-layer suture with sterile, 3-0 nylone sutures. In instances of donor closure under higher tension, Dr. Wesley uses an absorbable vicryl suture for interrupted deep suturing in and around the areas of increased tension after undermining approximately 2cm along both edges to minimize tension on the wound. Dr. Wesley prefers a standard to the trichophytic closure on patients with white hair, poor scalp elasticity and lighter haired female patients.

Dr. Wesley stays away from “cookie cutter” hair transplants and customizes his procedure for each patient. Using tiny, sterile, hypodermic needles as small 20 gauge (approximately .88mm), Dr. Wesley creates parallel (sagital) incisions to minimize trauma to pre-existing hairs and out-of-body time for the grafts. Dr. Wesley uses single hairs exclusively to re-create the critical hairline to produce natural looking and undetectable results.

Dr. Wesley places grafts up to 35 FU/cm2 in order to maximize growth yield and provide patients with a totally natural looking result. Coalition member Dr. Limmer’s hair survival study revealed that this may be the maximum density that will yield the highest percentage of viable transplanted growth. Thus, patients who require or want additional density are encouraged to return to him for a second procedure.

Dr. Wesley is a board certified diplomate of the ABHRS (American Board of Hair Restoration Surgery) and is a member of the ISHRS (International Society of Hair Restoration Surgery), the AACS (American Academy of Cosmetic Surgery), the AMA (American Medical Association) and the ABA (American Burn Association).

Given Dr. Wesley’s experience and ability to perform high quality follicular unit hair transplant surgery with excellent results, I feel strongly that he should be considered for recommendation on the Hair Transplant Network. To view our high standards for recommendation, click here.

View some of their patient and surgical photos below:

1854 Grafts with Dr. Wesley

2172 Grafts with Dr. Wesley

1989 Grafts After 6 Months with Dr. Wesley

2160 Grafts with Dr. Wesley

2115 Grafts with Dr. Wesley

2263 Grafts with Dr. Wesley

2369 Grafts with Dr. Wesley

2265 Grafts Crown Reconstruction with Dr. Wesley

Surgical Photos

Introducing Dr. Wesley, His Philosophy and More Surgical Photos

I welcome input and comments from forum members regarding his potential recommendation.

To view our standards for recommendation, click here.

Onwards and Upwards,

Bill

Shadow of the EMpire State · #2 **Top** 05-12-2011, 09:58 AM

Quote:

Originally Posted by Bill - Managing Publisher

Dr. Wesley places grafts up to 35 FU/cm2 in order to maximize growth yield and provide patients with a totally natural looking result. Coalition member Dr. Limmer’s hair survival study revealed that this may be the maximum density that will yield the highest percentage of viable transplanted growth. Thus, patients who require or want additional density are encouraged to return to him for a second procedure.

(1) I don't know enough to comment on graft mortality above 35 FU/cm2, but it does seem that 35 FU/cm2 would leave an unsatisfactory result. Thus, the question is whether you want to plan a second procedure before the first is even finished. Of course, I understand that additional procedures can become necessary as hair loss advances, but I would hope to get a few years of "breather" time before I had to go back in---if I had to go back in at all.

(2) Also, the 35 FU rule would seem to rule out strip altogether. I think it'd be annoying for FUE, too, but with strip, it would be out of the question. Two incisions for one result? I'll pass.

(3) Maybe 35 FU really does promote the maximum yield, but just how much do we lose by going for more? Certainly, Rahal and others seem to have no problem getting a significant yield at higher densities. Is it as high as it would be at 35 FU? Maybe not, but I think it'd be worth sacrificing a few grafts to walk out of the operating room in the knowledge that you're done for the foreseeable future.

Cant decide · #3 **Top** 05-12-2011, 11:05 AM

I agree. I am all for being conservative but I think 35 FU/cm is a bit over the top. However, it does seem like he does good work and as long as it is made clear to each and every patent that he is very conservative and there are other docs who will do much larger sessions and the pros and cons to both. I have no issue with docs being conservative (Limmer, Bernstein, Shapiro). I do have a problem when docs don’t present the other option of being more aggressive as something they just don’t do but is still an option if they want to go elsewhere. I am not saying the aforementioned docs don’t, but I am just saying that I hope that they do. For example, if you won’t plant at over 35 FU/cm, thats fine, but tell your patent that other good docs do and why you feel that not exceeding 35 is a good idea. The same thing with how many grafts can be extracted in one procedure. I had a coalition doc tell me that I would be lucky to get 3500 and I ended up getting 5200 with another coalition doc. The first doc never stated that it was just that he did not feel comfortable doing it, just that it "Could not be done".

Carlos K. Wesley, M.D. · #4 **Top** 05-12-2011, 12:06 PM

Thank you for your comments. Your points are well taken. It’s important to realize, however, that the most important value is not FU/cm2, but rather the number of HAIRS/cm2. Transplanting 2-to-3-haired FU at 35/cm2 results in equal or significantly more hairs/cm2 (70-105) than densely packing single-hair FU at 70 FU/cm2 (70). Furthermore, by dividing out the micrografts as they naturally occur (rather than creating single-haired FU from a natural two-or-three-haired FU, you’re retaining the protective subcutaneous tissue surrounding the follicle’s base. By minimizing negative forces such as dessication and mechanical trauma from handling, you’re improving survival. Combined, these factors provide an extremely desirable density for patients with a single session.

Furthermore, to clarify a statement in the quote above, patients return for a subsequent session to cover a portion of their scalp not addressed during the initial session (e.g. a midscalp or vertex treatment following a treatment of the frontal third). It is during the subsequent session that they may use a percentage of FU to also add to an area that they’d like even thicker. A single session provides ample density and does not require a follow up to the area treated. The “breather” that patients get after one session should last a lifetime.

Spanker · #5 **Top** 05-12-2011, 12:30 PM

I am sorry but I have to say that this doc has not shown enough impressive results for me to reccomend. There a some good ones, but is good what the coalition recommends, or does the coalition only recommend the best of the best? I personally would like to see some outstanding results before recommending a doc.

Sorry to sound negative.

Bill - Managing Publisher · #6 **Top** 05-12-2011, 05:23 PM

Guys,

Thanks for your thoughtful input so far. Please note that Dr. Wesley is being considered for recommendation at this time and not the Coalition of Independent Hair Restoration Physicians. To learn more about the difference, click here.

It's easy to become impressed by high numbers when referring to density. But the reality is, very few patients need more than 40 FU/cm2 in order to achieve an adequate illusion of density. Additionally, as Dr. Wesley already pointed out, 35 FU/cm2 using two and three haired grafts is much more densely packed than 60 FU/cm2 using single hairs. Thus, knowing the number of transplanted hairs per square centimeter is more valuable than knowing the number of FU/cm2.

In my opinion, Dr. Wesley is performing high quality follicular unit hair transplantation as shown by examples of his presented results on this forum. Thus, I feel he should be strongly considered for recommendation on the Hair Transplant Network.

I'd like to hear more input on his potential recommendation.

Best wishes,

Bill

Bill - Managing Publisher · #7 **Top** 05-12-2011, 05:26 PM

P.S. To give you an accurate picture of actual density, my hair density is approximately 40 FU/cm2 in the front, 30 FU/cm2 in the center and 25 FU/cm2 in the vertex.

RCWest · #8 **Top** 05-12-2011, 06:32 PM

Mean average on a non balding head is around 100 fu/cm2. It's been claimed by many doctors that you can lose half your hair before it is really noticeable. So basically around 50 fu/cm2 is all you really need around the edges. 35 is kind of low when some doctors can push 50-60 in one pass, but judging by Dr. Wesley's results he seems to be doing a very good job. He has my recommendation.

Shadow of the EMpire State · #9 **Top** 05-13-2011, 02:45 PM

I have no gripes with Dr. Wesley. Hell, I had never even heard of him before this post. But I can't help but feel that if a guy like Umar didn't make the cut, the standards must be pretty high.

TC17 · #10 **Top** 05-15-2011, 10:50 AM

The examples posted look very nice, certainly worthy of recommendation. As for Dr. Wesley's conservative approach, well, I'm sure most know that I tend to lean on the cautious side when it comes to hair transplantation, so I view that as a plus. However, because I know nothing about him or his work I cannot offer an opinion. But, if the physicians already recommended here are familar with him believe that he is worthy of recommendation, then that is sufficient for me.

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