Dr. Carlos Wesley

Hi, all. Firstly, thank you to the patient for posting such a nice testimonial. A few first-time posters have generously and candidly shared their experiences about my office recently simply because another patient of mine encouraged me to let follow-up patients know about this website: The HTN. The vast majority of our patients come directly through referrals from physicians, relatives, friends, and hairstylists rather than online, so most of my patients aren't already registered on the HTN. That's why the testimonials are predominantly from first-time posters. Regarding the consultation fees: while I originally provided free afternoon consultations and tried to hastily fit in a larger number of consult patients in a shorter period of time, I began charging a $100 consultation fee earlier this year in order to spend more time with fewer patients. I don't think it is unreasonable for a physician to charge for his/her time and the vast majority of my patients state that the one-hour discussion we have together is extremely thorough and a good value. The other consultation fees quoted by "formertrackstar" are also accurate ($200 and $250) and have been for quite some time. Finally, regarding Dr. Walter Unger, I certainly feel privileged to have trained alongside him prior to his invitation to partner in his practice. His vast experience in hair restoration surgery spans nearly 50 years and seeing many of his follow-up patients from 20-30 years prior has been extremely valuable roll in shaping my approach to younger patients. He has been the lead editor for the main physicians-reference guide for over 20 years and really does care a great deal about the field of hair restoration surgery.

Thanks for your comments. And, I agree, Slickers. I certainly regret not having a better "before" image from the front to reveal the true extent of his initial hairline recessions. Important thing is...he remembers!

That really depends on the cause of the loss. While "shock loss" that is indirect and due to the micro trauma of the local blood supply from making an incision near a pre-existing hair follicle is temporary, direct trauma to pre-existing hair follicles from rushing recipient incisions at the wrong angle or direction may not be temporary and isn't simply "shock loss". Again, it all comes down to how slowly and carefully the recipient sites are made when working in hair-bearing areas.

Thanks for this great question, OttawaJay! This is a postoperative phenomenon that really varies from practice to practice as well as from patient to patient. Shock loss ("postoperative effluvium") is something that affects women more than men. In our practice, we generally state that significant postoperative effluvium is seen after about 40-50% of female cases and 10-15% of male cases. When it happens, it occurs 2.5 to 3 weeks after a session, but grows back 2.5 to 3 months postoperatively. In an area that has been treated, 1 to 3 out of every 10 hairs may temporarily fall out before regrowing. The greatest emphasis should be on creating the recipient pattern to avoid transection of existing hair. Now, that's not to say areas of future loss (e.g. your widow's peak) should be avoided. Quite the contrary, actually. It's essential to treat the areas of future loss so that patients are never obligated to return for a follow-up session in order to simply make it look natural again. For example, not treating a tuft of hair in a patient's central hairline would ultimately leave an unnatural bald patch after a patient has progressed with their normal course of MPB or FPHL. They would then have to return to treat that in order to simply look normal again. The key is simply attention to detail and taking a good 2+ hours when designing the pattern in order to carefully navigate through areas with pre-existing hair that requires thickening. This enables the recipient sites to be carefully created at the exact same angle and direction of the pre-existing hairs (even if there are sudden changes, as seen in a cowlick). Rushing through this process, like an automatic sewing machine, increases traumatic follicle transection which may not always be temporary. Fortunately, the majority of the physicians on The Network are great and don't rush this process. But, as a patient, please don't be afraid to ask your surgeon how long it takes them to create the recipient pattern.

Thanks for the kind words. During initial consultations with our office, all details of FUT and FUE are highlighted for patients. Although some patients are adamant about undergoing an FUE harvest rather than strip, most patients (who are good candidates for surgery overall) are given both options. In general, if patients wish to wear their hair only a few millimeters in length, I'll suggest FUE as the better option. We've been performing an increasing amount of FUE over the past 2-3 years in our office. Currently, approximately 20-25% of my patients opt for this approach. This large 2701 FU session of FUE took place over the course of two days.

Thanks so much, RCWest and PuPDaddy, for the kind words. In response to Shampoo's question: the patient is taking finasteride 1mg daily. He began that regimen at the time of our first meeting together which was two years before his first hair transplant session with me. So, while the medication seems to have held some of his hair loss in check, it did little to promote growth in the frontal portion of his scalp. That's what led to our determination to undergo hair restoration surgery.

Thanks, Spanker! While many young patients push for the lowest possible hairline, this was a design that we all felt was most appropriate for the long term. I appreciate your feedback.

Hi, Sean. In limited studies, it has been reported that autologous platelet rich plasma (PRP) injected directly into the scalp can increase overall hair counts and hair diameter while microscopic findings reveal thickened epithelium, proliferation of collagen fibers and fibroblasts, as well as greater numbers of blood vessels around hair follicles in areas that have been treated with PRP.(1) Regarding your question about treatment in a transplanted area, it is certainly a possibility that any dormant or miniaturized follicles may benefit from PRP. However, since newly transplanted hair follicles may still be growing in up to 18 months after a session, we do not want to interfere with a transplanted area until 18 months after a session. A non-treated area (e.g. a crown after a HT to the frontal third) is certainly possible. Thanks for your question and I look forward to providing more information in the future! (1) Takikawa M, Nakamura S, Nakamura S, Ishirara M, et al., “Enhanced Effect of Platelet-Rich Plasma Containing a New Carrier of Hair Growth” Dermatol Surg 2011; 37:1721-1729.

Good question, Levrais. Thank you. Patients who have previously undergone an HT may be candidates if one of the following criteria are met: 1) They should be at least 18 months out from a prior session in order to ensure that PRP treatment does not interfere with growth of newly-transplanted hairs from a prior session, or 2) the area undergoing PRP therapy is separate from the area treated by the HT (e.g. HT to frontal third may receive PRP in the crown).

Thanks for the kind words, guys. The transplanted follicular unit (FU) details of the session are as follows: 1s 599 2s 1123 fine 2s 92 3s 318 fine 3s 65 FFs 32 Total 2229 FU

Drs. Unger and Wesley are initiating a thorough investigation on the effect of direct PRP injection on hair caliber and growth. If you are interested in taking part, please read below. The investigation takes place at our 710 Park Avenue office in Manhattan. Platelet rich plasma (PRP) has received much attention in hair restoration surgery (HRS). While investigators have published studies suggesting the benefit of incorporating autologous PRP into surgical treatment, evidence of its clinical effect from direct injection is limited. Furthermore, as not all PRP concentrates investigated are of the same growth factor (GF) composition or platelet concentration, any clinical benefit has not been attributed to a "known" PRP solution. Our current clinical study achieves both: matches patients' own molecular profile of the PRP they receive with any focused, well-documented clinical benefit they may experience. Stated differently, we'll know exactly what we're injecting and we'll know exactly what effect (if any) is has. Although previous investigations have suggested autologous (meaning from your own body) PRP's influence on hair shaft diameter, these studies either involved only a limited number of patients, limited measurement parameters, or were done in vitro. Our office's study sets out to establish a direct correlation between change in hair caliber and density (if any) and patients' platelet concentration and their actual growth factor profile (via an ELISA method performed in association with the Mt. Sinai Medical Center). Despite encouraging data suggesting its benefit on hair, solid scientifically-valid data confirming PRP's efficacy in HRS is sparse. Therefore, patients taking part in our investigation will only be charged the material cost of performing the PRP procedure. In addition to an office visit approximately 2 weeks prior to the procedure for hair measurements, patients will follow up at three additional time points after the procedure: at about 2, 4, and 9 months. We are looking forward to better understanding the true nature of PRP in the treatment of hair loss. If you are interested in learning more about this investigation, please contact Dr. Carlos K. Wesley's office at 212-249-9393 or email his office manager at drwesley.office@gmail.com

I've attached a close-up image of his donor scar that was taken during his recent follow up.

Thanks for the comments. And, yes, NEWHAIRPLEASE, it makes me look forward to having grey hair someday too!

Yes. It's true. He returned to the office just after having showered. While it's nice to see patients clean, dampened hair doesn't have quite the full appearance. He is, however, thrilled to have something new there to style!

Hi, everyone. Thank you for your interest in the investigation. While I can't guarantee that the idea will "blow everyone's mind", I do believe in it and hope that, ultimately, it will provide a logical approach to addressing the various imperfections of current methods in our field. I'd just like to provide an update on the anticipated timeline. We are hoping to carry out a follow-up investigation near the end of this summer with the hope of having the instrument available for more widespread use in late 2013. The secrecy surrounding this instrument isn't intended to provoke a response, but simply to ensure that we better understand how everything works prior to making it available. It's true what "England" points out that patents should enable freedom to disclose, however, as I am an individual physician with an idea that I've been slowly and carefully developing for nearly 4 years now, I just simply wouldn't have the pocketbook to protect the intellectual property if a large group with considerable resources capitalized at this early stage. I appreciate your interest and I'll be sure and keep the community updated on progress!

Thank you for the feedback. He was quite pleased!

Thanks for your comments, guys. While I certainly wouldn't consider PRP a first-line therapy for psoriasis, it has been shown to thicken the epithelium, cause collagen fiber and fibroblast proliferation, and increase the numbers of blood vessels around hair follicles. Some literature suggests its positive effects on wound healing in plastic surgery and PRP has even has been shown to increase hair numbers and hair thickness. This is really the rationale behind using this method on this particular patient. The resolution of his psoriatic flare up was a bit of an unintended benefit. And, yes, NEWHAIRPLEASE. Research is going well. We recently received a research grant to further the work with the hope that it can help the community in the future.

This 30-year-old male with a psoriatic midscalp underwent a session of PRP (60mL concentrated to 3mL). The images (taken with a Folliscope) captured his progress over the course of the next 8 months. Within 5 weeks, the psoriatic scalp had resolved. The patient then experienced a subtle, but noticeable increase in density and caliber over the next few months. Measurement points were based off of anatomic locations (e.g. 15cm from left tragus, 11cm from left medial canthus, etc.) rather than tattooing the patients scalp. Therefore, while the regions captured were nearly identical week to week, slight variability in the location capture exists. Our office will follow up with global pics, video for an alternative view.

Thanks! He was quite pleased. Although he had a psoriatic scalp, the conditions that we are most interested in seeing resolve from medical therapy and remain quiescent prior to agreeing to move forward with hair restoration surgery are alopecia areata, lichen planopilaris (LPP), frontal fibrosing alopecia, etc.

This 39-yr-old man underwent a 2282 FU session to his frontal region in order to improve the density and coverage of that area. He was particularly concerned with the progression of his fronto-temporal recessions. At about 10 months after this session, he was thrilled with the results. Prior to this session the patient had suffered from psoriasis involving his scalp for nearly 10 years. In patients with certain dermatologic conditions involving the scalp, we feel that it is ideal to ensure that the disease is quiescent (controlled) for nearly one year prior to a surgical session.

Donor Scar from Strip Harvest

This 57-year-old gentleman presented to our office in late February 2011 for a 2189 FU session. He returned for a follow-up earlier this month (9.5 months post-operatively) enjoying his soft new hairline that framed his face in a more youthful fashion. Donor scar images are also included.

Revision of scars is certainly one of the features that it is intended to bring to the community!

Thanks for your comments. The graft breakdown from this FUT session was as follows: 1s - 542 2s - 1015 3s - 297 FFs 79 Total 1933 Things are well on the research front. We are about 2.5 months into the clinical trial for the scarless harvesting method. Our office looks forward to presenting our findings formally at the 2012 ISHRS meeting. As I mentioned previously, it's a method that I and others who have learned about it truly believe in and feel will really benefit many patients down the road.

At age 34, this patient had already taken Propecia for 5 years. Although it slowed the progression of his hair loss in the vertex (crown) and midscalp, the effect of the medication was decreasing. A session of 1933 micrografts throughout his crown provided ample coverage as seen about 20 months postoperatively. Coverage of this diffuse area of thinning also addressed the periphery of the crown (outer concentric circle) that will continue to thin in the future. While his coverage is markedly improved, the acute angles of hair in the crown may necessitate two sessions to have a dense vertex.