Happy

i fully agree that a major stumbling block might be monetary issues. therefore, in my view this initiative will be driven by surgeons who just don't pretend to be ethical, but truly are: with today's technology and decades of experience in the ht industry we all know that surgeons can create outstanding results and leave patients very happy - but just in the short and maybe in the mid term; creating high-density, low hairlines for young patients would be one such example. however, being ethical means to look beyond the monetary aspect and what is achievable, but to first of all focus on what is best for the patient also in the long-term. and for this, i feel it should be compulsory to provide as much crucial information to the patient as possible so that he a. can finally make a well informed decision before any surgery b. is also able to properly monitor and manage the progress after a surgery i can't imagine that a patient would be able to do that without such reports. ps.: in terms of getting a better feeling for how long it would take to create these reports - can anybody provide information how long dr devroye needs for doing all the exact calculation of the bald/thinning area? maybe 10 - 15 minutes?

in the other thread "Looking for good HT doctor in India(preferably Hyderabad)" i noticed that so far only 1 surgeon, dr. mahdu is being recommended despite dr. a is also regarded as one of the world's top ht surgeons coming from india. but he hasn't even been mentioned here. why?

i had a read through your terms of service again, but can't find anything. hopefully, you can help. thanks

surfarosa, it's great to hear about all your efforts, your passion and which i fully share; and even more, this is wonderful news that you got your principal ok by the consultant of one the world's leading ht clinics, h &w. to me, this is the most obvious evidence that we are on the right track with those reports. i fully agree, that it would be wrong to wait till a bunch of ht docs would agree on anything. because this would never happen. instead, progress is mainly driven by initially "weird" guys who take the plunge and act differently, even if this means just to provide additional but invaluable service that hadn't been heard of before. and if these trendsetters are successful, well, then others will gradually start and imitate them. it's that simple in life. in case h & w taking the plunge this would have another tremendous advantage: since h & w is already known for being very successful, this would definitely have an aftermath in this industry sooner or later. maybe, you could get h & w involved in this thread and to simply contribute in a way to make this vision become reality as soon as possible.

achieving outstanding results unfortunately doesn't equal being also a surgeon who is 100% honest in all the financial aspects. we all know that money is a very big temptation for anybody to suddenly change ethical standards. having said that it's simply impossible to agree/disagree with your stated belief, hence i won't comment on it. i would suggest to rather focus on the vision how the ht industry can be changed first of all for the benefit of patients - eg. how these reports could look. and i hope that also any surgeon or clinic will finally come foreword.

how is it then possible for him or the surgeon to answer questions "correctly" ?:confused:

louise, the same question goes for you: what is the average of transected grafts (in percentage) that you have in your surgeries?

i understand that you are talking about the fue procedure. in your experience, what is the average percentage of transected grafts that you have during your sugeries?

well, having such pre-op and post-op reports done shouldn't take more than an hour each. plus, most of the work doesn't have to involve the surgeon anyway: using a densitometer, counting the grafts on screen, measuring the shaft diameter etc. is all very very basic and can be done by almost anybody. and if you don't just want to have a rough calculation of the area of bald or thinning hair that needs to be covered, but very precise figures, then you get software programmes that do the calculation automatically for you (i think, dr devroye uses one of them). only, for checking the scalp laxity the doc himself needs to make his assessment. let's face it: the total transparency in particular with pre-op reports won't benefit certain ht surgeons for one very crucial reason: cheating / overcharging will become so much more difficult for them! just to give one example: as a patient when you know your average fu density plus average size of your hair grafts, then anybody can easily figure out when the amount of harvested grafts somehow doesn't match the size of the donor scalp that was cut out; or when grafts were split. being totally transparent is only a problem for those who have something to hide. on the other side, truly ethical surgeons shouldn't be afraid of such reports. it's rather the exact opposite as they are able to not only clearly distance themselves from any otherwise intransparent practices but, but first of all to provide all those already mentioned benefits for their patients.

for today i would like to ask your doc hopefully 2 easy questions: 1. do you sometimes split grafts into smaller units? (eg. a 4-hairs graft into 2-hairs grafts or a 3-hairs graft into a single-hair graft and double-hair graft) 2. on your website i noticed that it mentions a range of publications with quite groundbreaking topics - eg.: - conditions/advantages of large-scale surgeries with 4000+ fu's - measures to reduce the impact of post-op scarring with the strip method unfortunately, no content has been provided yet. would you be able to maybe summarise the most important information that the relevant publications contain?

i fully agree! and this is why i do love surgeons and clinics who are 100% transparent whilst always providing honest answers. that's how you build relationships in any area, of course also including our private life ;-) from what i have learned i also fully agree in this respect. anybody making these claims needs to be treated with suspicion. like you, i can't claim to be an expert either in the ht industry. and from what i have seen and read from tsisolani so far, he seems to be an outstanding ht surgeon with a passion to excel. as for his current fue technique and by just looking at the bare figures and his used punches, however, i get the impression that there is still room for him to improve compared to other, outstanding fue surgeons.

i hope, not to come across as being too critical, but i am a bit concerned about the size that your clinic uses for the 3-4 hair grafts. from what i have learned in my research is that if the size of the punch is too big (i.e. 1mm inner diameter), the chances are very high that this will result in miniaturisation of the neighbouring grafts in the donor area. in order to minimise this risk, punches with a maximum diameter of 0.85mm for the 3-4 hair grafts are being used, ideally 0.8mm.

many thanks again for your contribution also including tsilosani's response. as for his statements, however, i am not quite sure whether other docs and patients will agree with him. have a read through what another fue clinic, prohair clinic is saying on their website about damaged grafts during extraction process: "...an inexperienced team who does not carry out or know the FUE technique properly will damage 5-10% of the grafts. However, team Prohairclinic work exclusively using the FUE version, in which damage to the hair root scarcely ever occurs. This is why we guarantee that less than 1% of grafts are lost during the extraction process. This is far fewer than in other commonly used hair transplant techniques." "Currently we are able to transplant up to 2000-2500 grafts (follicular units, sometimes also known as grafts) per day on the same patient. This means that we can transplant up to 4000 grafts on 2 successive days. This is much more than an average strip/FUT procedure." as far as i know the prohair clinic doesn't use any power driven tools at all exactly for the reason to keep the transection rate that low.

well, i contacted dr cohen a while ago about the tool. so far, he hasn't come back and to provide further information about this tool. i wonder why? does it exist at all? on the other side, it looks as if other clinics seem to use similar devices as talizi in the thread showed.

in other words, your doctor uses a power driven tool for creating the punches. as far as i know all the world renowned fue surgeons only make the punches manually as this seems to create less transected grafts. for example, the prohair clinic guarantees that less than 1% of the extracted grafts get lost due to damage. what is your surgeon's opinion on that?

this sounds great. would you be able to provide a real-life example how such reports look, eg. from a patient who had more than one surgery done with your clinic.

hello surfarosa, i am glad you took the opportunity and started a very important topic that could shape the future of ht: how to best plan, proceed with and manage a ht in the long term i get the feeling that so far most people who finally decide to have a surgery done might do a lot of research beforehand. but we don't really know the very basic but crucial facts about our own hair status before it comes to the surgery: - average density of the fu's in the donor area - average number of hairs per grafts - maximum number of available grafts / hairs for surgery (depending on strip or fue) - percentage of miniaturised hair - diameter of the hair shaft - area of bald or thinning area in my view these facts should all be part of a "standardised" report before any surgery is being done and as you pointed out. additionally, i would also like to have an evaluation included about the current scalp flexibility of the donor area (maybe on a scale between 1 and 10) plus - for all guys who need a new hairline - the potential length of such a hairline and as a result the minimum number of single-hair grafts that will be needed for a surgery.

surfarosa, i think your idea of a standardised report is a superb suggestion since this makes everything so much more predictable for a patient. and for that reason i would encourage you to start a new thread to discuss this idea more in depth and with as many forum members as possible. in case you don't feel to start one, i am Happy to do it instead.

also a big thank you from my side and for your contribution, talizi! what i really do appreciate is, again, your clinic's transparent approach. i personally believe that this will be the next big step in ht, in particular when a clinic is able to provide a detailed report as surfarosa suggested. now before i overload you with too many questions, let me just focus on the following one for the time being: since the clinic's assistants provide detailed reports about the amount and size of grafts that were harvested - what, in your clinic's experience, is the average size per graft of your patients? ps: i did a rough calculation of the picture with the hand written numbers that you provided. and the average was about 1.8 hairs per graft. and which is very low.

darren, i am glad that at least you found the links helpful without having any second thoughts. as for you, bill - of course, as managing publisher you can do whatever you like with your forum including its members. and if you decide to kick people including myself out, so be it. but what people here on the other side can expect from you is that despite any disagreements your fairness towards people who contribute here: in my last post i copied and pasted exactly the promotional link that i found in the thread and which i quoted. and not another one as you wrote whilst mocking me. i have just done a screen grab as further proof and evidence. as for the mentioned problems with my log-in password - please note that neither did i change it nor forget it. this is why i assumed that somebody from you admin guys (and who have access to the password area) must have changed it as it coincided with the timing of our disagreement. since you wrote that you haven't changed nor deleted it, there is just one last solution: beware, your forum got hacked! i am serious.

hello linchpin, your response sounds quite sensational: having had only very brief swelling plus no pain at all. i am sure that many strip patients will be very envious of you! as for the doc's command of written english, i don't mind his level of expertise as long as it is possible to somehow communicate. in my experience this is almost always possible even with people who understand very little english if there is a will in the first place. in terms of your suggestion to approach the doc privately - i am sure that the questions that i have could also be of public interest for other ht patients. furthermore, he would be much more flexible compared to a potential telephone enquiry as he can respond whenever it is most convenient for him.

this is a very good question indeed! and i am sure that the answer would be interesting for any potential ht candidate, (well, at least for me). in particular, because i noticed that it is so easy to cheat with a ht. and i remember with all my research work that this potential problem was - and probably is still being - discussed in many threads (i can't remember whether it was this or other ht forums). now the answer that i found for myself depends first of all on the type of surgery you have decided: 1. fue procedure with fue it should be relatively easy: since your head gets shaved before the surgery, the number of grafts that have been taken out can easily be spotted. so, if you take a picture of the donor site at least within days after the surgery, you just count the red dots in the donor area and which is equivalent to the number of grafts that have been taken out. at least in theory. because, practically speaking, this doesn't mean that the same amount of grafts also got implanted into the recipient area: not all the fue-drills are successful - eg. some grafts won't come out, some others might get lost due to transection; and the very first ones in the fue procedure often can't be used either. so, maybe there is a 2% loss of all extracted grafts (just to give you an example). to be sure, i would suggest to also take a picture of the recipient area and what you have already done. now if you count the incisions the amount should normally be less than the the amount of the dots that you counted in the donor area for the reason that i just mentioned. there is just one exception: sometimes ht surgeons split bigger grafts into smaller ones, "officially" for the reason to have more smaller grafts available for creating a natural hair line with single hair grafts. however, i also remember this created a lot of controversy within the ht world as being highly unethical: as everyone can easily imagine this approach is first of all much more lucrative for ht surgeons as it artificially increases the amount of grafts and as such the money that surgeons can charge their patients. to give you an example: say, you got a total of 1,565 grafts extracted and which would equal about 3,600 hairs if we apply the statistical average size of 2.3 hairs per graft. now if you initially agreed to pay, say $5 per graft, this would then come to $7,825. normally, if there is no splitting involved. because there have been cases when it turned out that the average graft consisted only of 1.5 hairs and which you can easily achieve by the above described procedure. so, in our example the surgeon could also create 2,400 grafts and which would come to a total bill of $12,0000 for having transplanted the same amount of hairs. not bad, isn't it. to avoid this costly scenario, i would therefore recommend you first of all make the doc confirm before the surgery that he doesn't split grafts. this way, you can be sure that the incisions that you counted in the recipient area is the total amount of grafts he can actually charge. additionally, you should also ask him to count each and every graft while he is extracting them. 2. strip procedure this is the much trickier one if you want to make sure that you don't get cheated but only get charged for the actual amount of grafts: it is very very very easy to split natural grafts into smaller units while dissecting the original slice of skin that was cut out of your head. to get round this i would suggest a multi-stage approach to be on the very safe side: a. pre-op consultation make sure that you know your donor density beforehand. i remember in one of the other threads "1 EURO PER CRAFT STRIP, 2 EURO - FUE" the relevant surgeon used a densitometer to examine the donor area. the magnified fu's were then shown on screen so that the patient's fu's per cm2 could be calculated precisely. furthermore, you can also check the percentage of miniaturised hair and which shouldn't be used for ht (see also the other thread: "transplantation of miniaturised hair?"); finally, you can also have a look yourself what the average size of your grafts is. once you have got these figures, you can calculate very precisely the length and width of the sliver that is needed. say, your average density of usable fu's is 80 per cm2. in this case, if you wanted to have 2,400 fu's transplanted, you would then need 30cm2 of skin. b. surgery when it comes to the surgery, just take a picture of the cut out skin. when you later view the image on screen it should be possible to count the fu's on screen provided your camera allows for close-ups in the first place and that your image is sharp. additionally and to be on the very safe side, you can also place a ruler when taking the picture so that also the total area of the sliver can be calculated. in any case, you should be able to easily check whether the number of grafts that you have been charged is correct. or not. ps: from an ethical strip ht surgeon i would agree before the surgery that he provides such a documentation of his surgery so that the number of transplanted grafts can always be double checked - either by providing a photograph of the cut out skin as just described or, even better, by providing a relevant flatbed scan and which also only takes seconds! from an fue surgeon i would agree before the surgery that somebody of his team would count the fu's including their relevant size while they are being extracted. as soon as the extraction procedure is finished, i would then expect to receive a copy of the tally list.

good luck and tell me when you've found it!

bill, blake and wb280, i appreciate your efforts to provide advice to forum members eg. about best practice and to make sure that your forum is not being "hijacked" eg. for marketing and sales promotion reasons. that's great. and i can fully support you in that. let me just make one last public comment about our different views since the underlying thoughts should also be of public interest: to start with, i understand that you define "promotional links" as any links that contain services that are being offered, eg. hair transplantation. and that you would remove any of those links if they were part of a post. now what makes it really difficult to digest your approach with "promotional links" is that obviously you apply different rules and don't do a clean sweep as wb280 suggested earlier. i give you one example: in one of the other posts entitled "1 EURO PER GRAFTS STRIP, 2 EURO - STRIP" the author venividivici included such a promotional link and which is (promotional link removed) however, even after more than a year this promotional link hasn't been removed yet. i personally found / find it great since it gives readers like me the chance to find out more about eg. clinics that were previously unknown, and to contribute actively to this forum by making further comments. however, when you guys on the other side remove "promotional links" which you find listed in other posts such as mine, this then not only smacks of censorship and unfair treatment - in my case i can assure you that this is also highly demotivating not to contribute anymore. anyway, for the sake of the whole community it would be great if in future you guys could focus instead on much more important issues: to regularly and carefully check and clean sweep those vicious people who are trying to use your platform and harm us forum members: only today, again i received 2 more private messages from obviously fake "ladies". and this is not just a nuisance to me but can also be very dangerous for anybody here in the forum who is not familiar with phishing and even more sophisticated frauds such as creating fake love relationships with affluent guys in order to finally suck money out of them! ps.: bill, no, i am not affiliated with nor have any vested interest in any of the provided "promotional links" in case this is your concern. by the way, whoever from the admin team (was it you bill?) changed my log-in password recently - please feel free to do so again in future whenever it suits you.

there is a huge difference between your threshold figure and the one that dr. bernstein mentions. what is your explanation for that? what are the signs then so that you can distinguish between a miniaturised hair and one in the very early anagen growth phase (single hair-fu and multiple hair-fu)?