Dr. Ron Shapiro

There is a good potential to addres the hairline depending on other factors we see when we get to examine you in person. Part will be what your other goals are and how much donor you have left . But in general ...it is not hard to create the appearance of a lower hairline with a smaller amount of grafts than one would think ....because the base is now there. It is not always doable...but often is. The idea of focusing on oneside slightly more than another is one of approaches that can be used if the patient is ok with it. We will be seeing you in soon

As a physician it feels great to know that you are happy. Thanks for sharing your journey with everyone. It really helps us when they come in for a consult to see the time frame of change take care and see you soon

Thanks for writing your review. Look forward to seeing you again in January. I wanted to make a briefcomment about your case and why it is important to individualize plans based on a persons specific situation. Like you said.... in your case naturalness was the most important issue....with density and shape a close second. In my assesent of your concerns.....any degree of naturalness would have been very uncomfortable to you. In planning your procedure we really went back and forth and how aggressive to bring down the hairline. There is intrinsically a greater risk of a patient feeling the transplant is natural natural the more aggressive we are....so we erred on the side of making it a little more conservative and making naturalness more assured. We hoped maybe this would be aggressive enough..... but knew that if you liked the naturalness we would have the ability to titrate down the hairline more safely to the perfect Level. I always like being in that position rather thang having a patient be even slightly uncomfortable with naturalness. We still have 3 -4 more months of growth to hope the center part becomes more dense. And at that time we will also have a even better idea of exactly how much lower you will want it. But it will be fairly easy now to build on this base and safely bring it down perfectly without any risk of you feeling uncomfortable.... if that is what you desire. The risk of doing this in the first session with your focus on naturalness made us decide to be a little more conservative. In some cases we can be a little more aggressive the first time. In your case with naturalness being so important we sort of decided to go this path. Hope that makes sense to everyone. Once again looking forward to seeing you next month. Take care

I did not realize people were wondering about my brother so much. Yes. My brother Paul who was with me for over 15 years decided during the pandemic it was time for him to retire( or take a long sabbatical). He loved doing hair transplants but was having some neck pain issues from the long surgeries and just felt it was time to enjoy life a little. If any of his patients need to contact us for any reason....... Dr josephitis and myself will take over Pauls past cases. In addition Paul will fill us in and bring us up to date personally on any history of past patients he has done to ensure continuity of care. We still are in constant contact as he is my brother and lives near by. So he was not removed....he just decided to slow down and enjoy the roses

Yes. My brother Paul who was with me for 15 years decided during the pandemic it was time for him to retire( or take a long sabbatical). He loved doing hair transplants but was having some neck pain issues from the long surgeries and just felt it was time to enjoy life a little. If any of his patients need to contact us for any reason....... Dr josephitis and myself will take over Pauls past cases. In addition Paul will fill us in and bring us up to date personally on any history of past patients he has done to ensure continuity of care. We still are in constant contact as he is my brother and lives near by.

I do alot of writing and lecturing about hairlines. I understand why you would like to just try and " "thicken up what you have". But in my opinion ( and the opinion of few other who have answered you, the current position and shape of you hairline is wrong and unatural....if all you did was make it thicker there is a real risk it would just draw more attention to its abnormal position and make things worse. In addition you would be depleting your donor more while doing this. There are other factors that would take too long to explain that makes this not the best course of action. I understand that pushing out grafts may seem like going backward. but in reality you have gone backward from the beginning because you went fro thin and natural to thin an unnatural and more unnatural ( the wrong direction ) each time. Dong more grafts with this pattern...even if it made it thicker ...would continue down the wrong path This would put you back on the right direction This is what I think from the photo ii see. Of course it is not the same as seeing someone in person and being able to walk all the way around them and observe from multiple angels as well as assess the amount of donor left which is critical. I guess could alter my opinion if I saw something different in person, I am not sure if we ever got your age...but if you are younger than 35 with this many grafts put in the hairline than the need to conserve Grafs for potential loss in the midscale is critical. I will try and upload my chapter on hairlines and maybe my PPT lecture on it as a reference for readers to use . Unfortunately I won't be able to do that for a few weeks as I am in the process of finishing the 6th edit of the textbook I write with her docs and it is past the deadline. If you would like to call me to talk on the phone about this let me know at by emailing me. Sorry to be negative about your desired plan...but I do think that it would be a mistake....it has been a mistake so far

We went back apt 6 month later and did a little grafting to soften hairline a little more. Sometimes this does not even need to be done. But most of the time it is but less agressively

Here is one example of how one can punch out bad graft with fue and it heals with little scarring and just punching out can make a patient look more natural. photo 1 shows pluggy grafts I corner photo 2 show immediately after one punch out photo 3 shows 2 months post op......healing still not complete and minor redness will disappear

I would be happy to give you more advice and try and refer you somone that match your needs. You will need a few visits so it would be best to fine the best match that is maybe local for you. You have to accept you will need a few visits to repair this. Once again I am sorry for your situattio And. am glad it was clarified it was to me.

I am sorry for your situation. When I was notified of this post I was positive it could not be me. Iecture alot on proper hairline design and the principles needed to create naturalness.....and your hairline violates some of he base principles. The shape and placement of the frontal temporal angle is one of the major problems. Even if it was "fuller and thick" it would not be natural to my eye because of the design of the temporal corners. They are too low, rounded, and blunted. The grafts are also too large misdirected mis-angled. But even if the grafts were done better ....the shape is wrong. The good news is that today with FUE these types of hiar lines can be converted from an unnatural to a natural look in sessions. The basic approach is to first remove and reshape the boarder with small FUE punches . This will give you a clean new palat and minimize the waste of those grafts already use,. You basically are trying to recirulate them to a better position,. Then you would do a grafting session to recreate the hairline shape to one that is more natural and will be proper for you based on your age, degree of hairless now and the future as well l as your donor reserves. You may end up needing to have a higher hairline than you originally desired .....but at least it would look natural now and as you age. Of course you need a full in person consult with whoever you go to to truly evaluate you current donor supply and potential loss over he years. But it should be fixable as far as making it natural. the scar can usually be fixed with a combination of FUE and SMP. sometimes a resection will help depending on the degree of tightness. I know many of he doctors mentioned above and feel they are excellent and can do this type of repair. Jerry Wong, Konior, Bruno, Lorenzo, Deveroye, Feriduni are all great. there are other mentioned that are good with getting density but it is very important at this point that you also pick someone who understands how to best use the donor supply and not deplete it Yours will have already been somewhat tressed

I am glad you like the video. We are planning on trying to use video more often because I don think it give a more accurate representation of what the results are. Some times it is hard to find the time. If anyone would like to see more of the immediate post op photo to see the pattern we transplanted let me know. We posted a few but I have it from every angel take care Ron shapiro MD

Hi mmac6084, I remember our first meeting very well. You were in such a bad place. I could feel your pain. I will never telling me how your young daughter asked why you had painted your head or the look on your face when you told it. I am glad I could help. I have done a lot of Pro -Bono work for patients over the years. Many have had terrible problems from accidents or burns…. other have had iatrogenic induced problems from other physicians. The one thing they all have in common is the negative effect it has on their life. There is no better feeling for me than when it works out like it did with you That is a gift to me. I am glad we could help …..and excited to see how far we can push it (safely) as we continue to work together. You have helped other patients because what we have learned in helping you we can apply to others. WITH RESPECT TO THE PHOTO OF ME AT THE GLI CLINIC 7 YEARS AGO, I FEEL I NEED TO MAKE A COMMENT SO IT IS NOT MISUNDERSTOOD OR MISLEADING. As you said that photo was taken almost 7 years ago. I feel the need to explain this photo so it won’t be taken out of context and be misinterpreted. I have been at odds with GLI for many years and have asked them not to use this photo. THE STORY IN BRIEF: GLI was started by an ex-patient of mine. This patient had worn a hair piece for years, was a type 7-8, and not a candidate for a standard transplant. What I was able to do for him many years ago ( ~1999) was a small FU transplant on his sideburn & hairline so he could wear his hairpiece behind my hairline thus making it look more natural. I had not seen him for years after this procedure, and sometime around 2008 he came into my office very excited to show me his new SMP shaved look and how it had enabled him to get rid of his hairpiece. I was not very impressed by his SMP shaved look. To me it was too harsh and a little blue. But he was very happy with it as it had helped him get rid of his hair piece. Also with him was Darren, his business manager. Darren also had had an SMP procedure but much milder and just to thicken his thinning crown. This actually did not look so bad. They told me that they were opening up an SMP clinic ~1 mile from my office and wanted to know if I would work with them in some way. They said they had improved the technique and were getting better results. My gut told me not to really trust these guys. On the other hand, I was very curious to learn more about SMP, which was relatively new back then. I had heard conflicting stories about SMP’s potential to be useful as an adjunct to hair transplants (i.e. camouflaging scars, increasing the appearance of fullness in patients with limited donor, etc.) I had found it difficult to get information about this technique. Most groups were very unwilling to talk to anyone about their techniques. I thought this might be good opportunity to see with my own eyes what it was capable of. So I told them I would like to see what they were doing before doing anything with them. ALMOST IMMEDIATELY I BECAME FRUSTRATED AND DISILLUSIONED WITH THEM. They really did not want to share anything. They would not let me see their ink, needles, or watch a procedure. They said it was “proprietary”. The actually had the gall to use the excuse that they were “worried’ if they showed me any of their techniques I may use them improperly and hurt patients. It was insulting. Also, I was not impressed further work I saw coming out of their office. It was during this short period of time that they asked to take a photos with me. It was obvious they just wanted to use me and my name and medical license for financial gain. I have not had a good relationship with them since. I sent a letter years ago asking them to stop …obviously they have not. The original owners sold GLI to a different owner a few years ago from what I heard. I have no knowledge about the new company, their work or their practice. If they are using my photo I will have to contact them again to tell them to stop. The point is I never had a relationship with GLI. What I took away from that experience was 3 things. • It was going to be difficult to research and learn the truth about various SMP techniques due to the nature of most of the current clinics. • That although I was not impressed with the naturalness of the work I was seeing…. a surprising number of the patients seemed to be happy with even mediocre work. It made me realize that if the work could be improved it may be a useful technique • There was definitely a population patients with no more donor hair and scarring that were helped by this technique Since then, Nicole and I have spent the last 6 years researching SMP. If I was going to offer it at our clinic I wanted to make sure we offering the best work. We found it was like pulling teeth to get information As I said many clinics are very secretive and protective and will not share information. However we gradually found people who would share. I visited Rassman. We trained with Milena (Beauty Medical) both in Italy and at our clinic. We share information with other physicians I know and respect who are doing SMP (Ruston from Brazil, Deveroye from Belgium, etc.) And recently a few of the more well-known private clinics that broke away from the bigger chains have been more open and willing to let us share and visit….. to their credit. The knowledge gained has helped us (and I hope them) evolve the field and our knowledge about the difference between permanent and temporary approaches. Our technique continues to improve and evolve. We think we do some of the best SMP work in the field at this point There is still much to learn in this field and it is my hope that with more sharing the field will continue to improve. There is still much to learn. Any way I digress. I just wanted to clarify the photo as the way it was presented could be misunderstood. Once again I am happy for you mmac6084 and will continue to try and help you in any way I can Ron Shapiro MD

I'm proud to announce that Janna Shafer, my long time Clinical Operations Manager and friend recently received the "Distinguished Surgical Assistant" award at the 2015 ISHRS Conference in Chicago. I am very proud of her. It is the equivialent of the Golden Follicle but for assistants. The award honors surgical assistants with exemplary service and outstanding accomplishments in the field of hair restoration surgery. Janna started out as a surgical assistant in January of 1996 and quickly moved up to being the Lead Technician and Surgery Manager at Shapiro Medical. Janna has travelled with me to countless countries as well as many cities in the US to participate in live surgery demonstrations and workshops. At these conferences/workshops, Janna was an integral part of the live surgery workshop success, assisting me and also coordinating with foreign clinics to ensure demonstrations ran smoothly. Although at these conferences we are offered the use of other volunteer assistants, It is extremely difficult to demonstrate our unique techniques at other clinics who may not cut grafts or place grafts in the same way we do in our clinic. Janna was instrumental in us being able to demonstrate our technique. She also would help other physicians if they needed assistance. She usually takes part in the Surgical Assistants Program and workshops at the conferences each year as faculty and speaker. This year (2015) she was in charge and chaired the Surgical Assistants Program in 2015. In the 20 years she's worked with Shapiro Medical, she not only answers questions from patients (often patients of other clinics) but from her peers and other hair transplant physicians. I can't thank Janna enough for her dedication and hard work at SMG and can't think of anyone more deserving of this award.

Good questions and answers.

I am not sure if we posted these photos yet. I think they are interesting and educational. They show how discrete the SMP impressions can be today. In this case impressions and irregular edges. I'm not sure why or if this was intentional. I'm not sure if this impression was made with one needle or three tiny needles to create this irregular border to the impressions. I know some of the clinics have talked about purposely creating irregular borders. These photos also show that the density and central area is less than on hairline and that the depth of the pigment is very superficial. This case was done by GLI. I would love to get the same types of photographs from the clinics selecting compare and future I will try to do this. FIGURE 1: this figure shows a close-up view of the SMP proxy one month after the procedure FIGURE 2: this figure shows a macro photograph of the SMP in central area. The density is approximately 90-100 impressions per square centimeter FIGURE 3: this figure is a macro photograph of the SMP at the hairline. The density is approximately 40 to 50 impressions per square centimeter FIGURE 4: this figure is macro photograph of some FUE grafts extracted from an SMP patient. You can see the pigment is very superficial just at the touch of the epidermis and dermis. This last photo was taken by my assistant Tom and I am glad he thought to take it