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

As I mentioned in my previous below FUE into a scar is great tool and appropriate for many patients as the first step. Sometimes it is all they need to fix the problem. HOWEVER in some situations SMP may be the best first step. Sometimes patients will want or need both once again depending on the patients unique situation With the more permanent ink you would not have to do it every two years. I have personally seen patients that had it done SMP over 4 years ago and were still glad they did it. Some of them did a little FUE afterward but because the SMP was their then did not need to use as much as they would have without the SMP. I don’t think you can make a blanket statement…these are all tools with potential positive and negative and the patient just has to be educated honestly and hopefully have a physician that can put the options in perspective so they can come to a mutual decision that is best for that patient. HARRIS is right that beard hair is a great source. It is very easy to get compared to leg or body hair. However you have to careful with beard hair. You have to be very careful about using ONLY beard hair in a scar....or in any solitary area for that matter. The reason is as follows. Beard hair is usually very coarse and if you have a monopopulation of coarse beard hair next to monopulation of normal donor hair it can be very noticeable …..do to the contrast in character of the two populations of hair For example… I recently saw a patient that had beard hair done on his crown because he had run out of other hair. The hair grew well but it looked terrible. It was so much coarser it stood out like a sore thumb. He described like a spider on the back of his head. The same optical effect could happen if you only used beard hair in scar tissue. Currently we use beard hair as filler and mix it with regular donor so it won’t stand out. If you have enough donor hair you don’t need to use the beard hair first....that is my opinion. These are subtle points that we learn over time from doing many patients. One glove does not fit all. Leg and body hair is another cool source of hair that has gotten a lot of attention the last couple of years. The problem with leg or body hair is that it is very unpredictable with respect to survival and density. It will not hurt you or look bad (so it is safe to do) and it may work well (I have seen a few amazing results…just a few). But it is notoriously unpredictable when it comes to percent survival or how much change in density it can produce. This is due to a few reasons: · only 1 hair grafts are produced · they are typically much finer than regular donor hair · their growth cycle is different than normal hair with a much greater percentage going into telogen and staying in that phase for a long time. · They are more fragile and prone to damage As I said sometimes the result can be great…. But sometimes it is near zero. If a patient spends a lot of money on this and the growth is poor he will be very disappointed. Recently Umar reports good results with body hair on a more consistent basis. He is the only one I have seen report this Most of the other physicians that I know who have done a lot of body hair say it is still very inconsistent in their hands….they occasionally hit a home run…but too often for their liking a significant percentage gets very poor growth. I believe Umar has been asked and accepted to talk about this at the next ISHRS meeting. Hopefully he will be able to share what it is he is doing different because it would be nice to be able to use it more often. RE:price….I agree with DAVIS91 The price being asked is outrageous. It should be less So while HARRIS opinion has some valid basis and I understand his opinion….In my opinion it is not so absolute and I think I would be careful about making a blanket statement. Allot of hair transplantation is weighing the positive and negative of different approaches in different people ...including the emotional aspect.

I agree some of the comments by Davis 91 and Scar 5. It has been frustrating getting answers from different SMP companies that perform the procedure. They are very paranoid that someone is going to "steal" their process. Sometimes I wonder if the process is that much different between them or they just want to create an illusion of a difference. They talk about different needle size, different depth, different inks, etc. The only two that have been totally open , which I respect, have been Rassman (who has let me watch him) and the Bella Medical (who have let me watch them). Rassman alluded to the fact that although technique and equipment is important…… you need experience and a feel to get the right depth and consistency of the pigment. To his way of thinking, this was just as important as the machine and needle that is used. He is conservative and from trial and error has begun to know who he can help and who he can’t.....I trust his judgment. GLI basically won’t tell me much of anything....but because they are close to me I get to work with them on some patients....I have seen their results improve over the past 3 years....once again probably due to learning from mistakes. In the beginning I did not think their "dot" was tight enough or consistent enough and I saw a little bluish tinge. Lately their results have been really good with the pigmented dots very tight and discrete. They have been using lighter shades of black (a more greyish black) that seems to look good with most brown to black hair colors. I am still not sure about long term color changes(how often it occurs) but they say it is less. The new theory is that they not imitating the surface color as much as the color observed by the eye when the hair is just entering and a millimeter below the skin. The optical explanation I have heard is that refraction of light makes most hair shafts look sort of a blackish, greyish at this level. On my patients I send to GLI I make sure they stay behind the hairline and do not create a wall. GLI have done a good job on the few I worked with them of keeping it lighter there. Bella Medical I just saw does one case and I have to say that initially post op it looked really great... Scar 5 is right about the trickiness of having ink stay in scar....It will. But you have to do a little conservative trial and error to see what depth and density will work... He is right that if you do too much on the sides it and not in the scar it will just increases contrast. But if you just do it in the scare the scar can stand out only darker.....there is an end goal to get the scar and surrounding tissue about the same shade and this looks goodMost of the scar revisions I saw looked much better after the first one but needed a few more procedures to blend. Doing FUE into the scar as an adjunct I have not discussed that can have a couple of benefits: · Hair in the scar giving slightly more density and texture to the scar that works well with th SMG · Aso after transplants are done in a scar the scar tissue changes and becomes more like virgin tissue... It is like multiple small skin transplants that replace the scar and stimulate new skin. Because of this....SMP may be easier to do in a scar that has some FUE in it first. Although GLI is technically doing good work....they are just too secretive for me. I have offered to try and explore how to improve the use of this tool buy working together on cases and learning and adjusting. But they will not let me see their ink, tools or procedure. They get mad and refuse if a patient asks for me to come and watch. How can I totally recommend something If I don’t understand it totally. I can say that the patients we have worked together on for the most part have been glad they did it. Some very happy….some happy but hoping for a little more effect. I did not want to just compete against them as that is not my nature. I had hoped that we could work together and learn together. But due to their secretiveness and my feeling that this is a great tool that I want to understand I know plan to learn as much as I can about it over the next year. I will start by going to Milan to learn at the Bella Medical course. thier technique. I will probably visit Rassman again if he lets me. If I feel I understand it enough I may start to offer it at our office. I think doing them in a HT office is much better for a few reasons. · You can incorporate it with Hair Transplants on a more consistant manner and create a better Master long term plan · You can use local anesthesia so it does not hurt · You can combine it with FUE I GLI starts to become less secretive and wants to work with me with total transparency I may try to work with them….but I doubt this will happen….unfortunately. By the way …I think the price is too high also. Not sure exactly what I think is appropriate but 5K seems like a lot. With respect to scar revisions.......as a potential different approach....I would say that over 80 percent of the time if: · the scalp is lax · and you only go for existing scar · and the scar is 1cm or less · and you use acell ....you can improve it signicantly..... Therefore if it has not been tried and the patient is comfortable with this it is usually always worth a first shot........However even though 80 percent of the time the revision works and only 20% of the time it does not work....if you have the bad luck to be in that 20% group…….. than for you it does not matter that the risk was low.....For you it happened. Therefore a patient who undergoes a scar revision has to understand that even if everything is done perfectly ......there is that small risk...that could happen. This I think is what happened in Scar5. He could have gotten a good result but did not. Sometimes there are factors that can help you guess if the odds are more in favor for you or more against you. · If your scar is not that wide and your skin is lax and you only had one procedure.....chances are good · If you have tight skin, the scar is wider than a cm; you have had attempts before that failed, etc....the odds are worse. Scares over the mastoid process are harder to repair due to force vectors. We now us something called Vitrase in patient with tight skin as it can create more laxity in some people.....It does not work as good in scar repair. But on people how have tighter skin on the first time and you want to try and get a slightly wider strip it is great. We also will now use Acel l in the scar during a scar repair because eit can make the tissue feel more normal as it heals.

By the way,.....I understand Zups logic from a "purely surgical and technical" ""standpoint....but it does not take into concideration FTS anxiety about another incision....or the near immediate improvement FTS could get from SMP. Each patient is different. In some cases a scar revision would be the first step. In others FUE. In my opinion for FTS case, SMP would be the best due mostly to his concern over another incision. Because he had two previous surgeries before he came to us for a repair. So his donor is no longer virgin and less predictable. On the last surgery we took out scar + hair. In a scar revision the incision would be not as wide and theoretically may have less chance of wide scar. But because it is not 100% sure and because of FTS concern I lean toward SMP at this stage.

I just sent formertrackstar an e-mail asking him to call me when he has a chance so I can go over the different options I think are available to him. I understand his anxiety about having another incision made in his donor area. Even though there is a good possibility it may help …..there is a risk it may not. Because of this and because of what I currently know about SMP….. I would recommend SMP to him at this time. I have been following the results of SMP the last 2 to 3 years & I think it is a good tool. It still in its infancy and we are learning more and more about it as time goes on Having said that,…. I've seen a number of people who have had scars just like formertrackstar, who have had SMP done and the majority were very happy. The degree of camouflage varied slightly but in all cases the scar was much harder to detect even with the hair short. In remotetrackstars specific situation...... Because he has anxiety about a scar reduction, I think that using SMP is the best choice to meet his immediate needs with very little risk. ONE pearl when doing SMP in the donor area is “not just do the scar” but to blend it through the entire donor area fading away as one gets near upper and lower borders of the donor area. I have seen SMP scar repairs done by all three clinics mentioned in this thread (Rassman, GLI, BELLA MEDICAL (of italy). The patients in all three clinics were happy they have had it done. Last month when I lecture that the Italian society of hair restoration annual conference in Rome...... Bella medical was there. Theygave a one half day seminar and demonstration on thier technique. I attended it and was quite impressed with their technique. I am even considering going over to Milan for a coursethey are offering to learn how to do it and bring it back to the states. There are advantages and disadvantages to the fact that the pigment will slowly fade over time. The main advantage is....in the remote chance that the patient does not like the results….. He knows he will not be stuck with it forever. Also you don't have to worry about the issue of the ink changing color. The negative is that it probably has to be repeated every couple of years. If I start to do this I would probably use the temporary ink on patients that are very nervous about the permanency. On patients whether this was less of a problem I would consider using more permanent ink. However this is all theoretical as most of the companies except for Bella medical and very secretive about their techniques and it's been hard for me to learn as much as I would like to so I can relay the information to patients. In former track star's case, because this is bothering him so much…. I think he would get near immediately improvement with SMP.….. with little risk. It would not rule out the possibility of doing a scar revision and more work in the future if he became more comfortable with that option. There's a lot more I could say on this because there are many nuances to this technique that are revealing themselves as more cases are done. As I learn more I will pass it on to you I've asked former track star give me a call at his convenience because it is easier to discuss all the positive and negative aspects of this complicated issue over the phone

Absolutely He is one of the most caring and ethical physicians I know

I have been following the improvements in micro pigmentation over the last year. Dr Rassman is one of the few HT physicians trying to see where this technique fits in the armamentarium of patients with hair loss. I have talked with him about the potential risk / benefits of the procedure and know that he is doing a good job of moving ahead carefully as he keeps exploring its use. I would like to share the limited experience I have had with this technique so far. I was first exposed to this technique when a patient about a year ago. An old patient of mine had had it done and came into my office. I had last seen him 17 years ago. He had been a repair case. At that time he wore a hair piece due to poor hair transplant at another clinic that left him with multiple scars in the donor area, a depleted donor area, and poor growth on top. He had very little donor left. 17 years ago we had very little options for him and what we decided was to do a hairline in front of his hair piece so at least the hair piece would look more natural. It worked well and I did not see him for the last 17 years About a year ago he walked into my office without the hair piece, his head shaved, and with the micro pigmentation. I was surprised at how it looked…. much better than I had expected this to look. From about 3 feet it looked like a person had shaved his head and let it grow for about a week...like stubble. It was very hard to see the scars. I did not like the look of the hairline...to abrupt. This type of hairline made sense in a young afro American but not an older Caucasian. In addition when I was closer than 3 feet I could tell there was something wrong because it had no depth. HOWEVER this patient liked this look. He was happy…He felt much better about himself. I had the same concerns that have been expressed above about the dye changing color, what happens if he turns grey, what would happen if this was done on a younger person and then they lost their hair But I could also see the potential for how it could help at least a sub population of HT patients. This sub population includes: · Patient with donor scars that prevent them from cutting their hair short · Patients who have done transplants but who still look thinner than they like. The reason for this could be one of many: poor donor supply, fine hair, poor growth, etc. Over the last year I have sent 6 patients who were in the above situation to have the micro pigmentation done. Because they were almost out of donor, they had very few options so we felt comfortable trying this. My experience so far is that these patients are very happy with their early experience. It was especially good for hiding donor scars...even with the hair short. It made them more comfortable with the appearance of density on the top as it blended with their old transplanted hair. In some cases the micro pigmentation enabled me to get a little more donor out because the donor area looked so much better and the new harvesting would be hidden. In addition I was careful to instruct the clinic doing the work to stay about 1 cm behind the hairline and fade away into it as I do not think it looks good at the hairline. I think this helped a lot. I think over time this technique has the potential to be a good adjunct to be used with HT. But we have to move slow and be careful and I am glad there are physicians with a lot of experience in HT exploring it like Dr Rassman. Here are a summary of my thoughts and a few precautions I have at this time: · I don’t think it is good as a primary treatment for a patient that is beginning to thin because he will be stuck with it after he balds and may not like the look. He will then be forced to do a HT · I also do not currently like it as a primary treatment for a bald patient because I don’t think it can create a good hairline. · With respect to the HT fading....Even if it faded in 4 years and they had to do it again the patients I talked were ok with this compared to where they were before having to use dermatch daily. A bigger concern was that it would change color over time. · With respect to color change…I don’t have a good feel for that at this time. Some of the patients I saw who had been out 2-3 years had a slight bluish or greyish tinge develop when I looked close…but surprisingly it did not affect the overall look and the patients were still happier than they were before the micro pigmentation I saw a man who had grey hair and with the light grey tattoo it made his hair salt and pepper looking…However I don’t have enough experience to know how much of a problem this will really be…and unfortunately the clinics I have worked with have not really helped me understand this. · I do think that it will be good for patients who have scars. · I do think that it may enable us to get more hair out of the donor to use on the recipient area in some patients · I think if one does it on top that it should only be done AFTER one has done hair transplants that have taken them 70 percent of where they want to go....this would be to improve them if they did not have enough donor to get them further · I think people that do this need to stay away from the hairline and learn how to fade away as they get close ( lowering density and lightening color) · I think that it is difficult to learn how to make the micropigmentation so it stays as a discrete pinpoint dot that imitates a stubble of hair.... there is a risk of it "bleeding" and coalescing which does not look good. This is dependent on the ink used, the needle used, the depth into the epidermis that the needle is inserted and probably other things. Dr Rassman would probably know more as he does this himself. I think a lot of clinics say they do it well….. But as was true with HT clinics in the past there are probably many don’t do it as well as they say. So until a good track record is developed by certain clinics I would say to be cautious..... One last note….this tattooing is not a discrete localized tattoo that would be noticed. When done it has to be done throughout the entire donor area or the entire recipient area so it creates a background….if it is done in a discrete localized area it would be noticeable. These are some of my thoughts so far....I will let you what I think as I continue to follow patients....for now I am only recommending it for patients that have very little choice. I will try and collect some photo to attach when these patients come back Ron Shapiro

I think that effect that M&M is talking about is simply the fact that the hair is combed up a little tighter more in this view. From what the physician that took the picture said there is no noticable difference in person and probobly a photo with a sligtly different angle would show this. You can sort of see that the comb is pulling on the hair. I am sure that if the other side was pulled tighter it would give that effect. I saw the patient after surgery and aslo talked to the Dr who took the photo and he assured me there is no real differene with this repect...dont read alot into one photo and one view. The main point is that Dr Wong and myself are extremely skilled with FU grafting and the results are very good based on the knowledge of how and where to place the grafts as well as what patterns to create. There may be some relative advantages and disadvantages to the type of incision used in certain situations but they are both small and refined and quite natural and the majority of the result is due to artistic skill in placing as well as gentle technique to ensure survival.

As Dr Meja said this z plasty technique is a good technique to try an minimise the appearence of a linear scar. It does so by reducing tension as he mentioned but also by breaking up the linear pattern so that any scar that does occur is less noticably to the eye. We somtime try it on people that have recurring scars that dont seem to resolve with simple excision. However as a primary closure the first time as Jotronic said it would be much more prone to transection and waste. But good lateral thinking outside the box Ron

Thanks everone for pointing out once again that DR LARRY SHAPIRO in South Fla is not me. It has been a thorn in my side for years that some of his work may be mistaken for mine. I do belive he piggy backe his practice to some degree on my good name. I am very grateful that when it come up you point it out My brother is PAUL Shapiro and he has been working with me for an number of years now. His work is making me proud as he has the same obsseive compulsive nature about gettign it right as I do. We also both had the same jewish mother that made us feel quilty whenever we disappointed anyone....another reason we try so hard Any way just noticed the post and had to reply thanks Ron shapiro

Hi All, Someone forwarded me this post. THANK YOU ALL FOR KEEPING IT CLEAR THAT I AM IN NO WAY RELATED OR AFFILLIATED WITH DR LAWRENCE SHAPIRO. WE ARE OPPOSITES. It is a shame we have the same last name. Thanks to the internet and a lot of your monitoring it seems that most of the time patients that have heard of me and my reputation end up with me. I have had to deal with this physician for about 10 years. There were a couple of time that patients looking for me called his office and, according to the patients; he led them to believe he was me. I have not had much recourse against this but if anyone has any experience of this happening please let me know as at that point I think I may have some recourse against him As far as the slow growth at 5 months. Dr Nussbaum has a great reputation and I know he is a caring physician. After multiple surgeries it can take longer to start growing. Also results in the crown are a little more subtle because we view more from the top which does not give as great an illusion of density as viewing hair straight on (which is why a front view photo may appear full and then a top view thin...a reason to see top views) I would not make any judgment until we give it a chance to grow and see true side by side photo. But the crown transplant will look thinner until it gets long enough to shingle over itself Take care Ron Shapiro