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JohnGage

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Posts posted by JohnGage

    Is it common opinion that a HT without taking finasteride or minoxidil is a waste?

    in Hair Restoration Questions and Answers

    Posted

    Finasteride is a drug that works by blocking the enzyme 5-alpha reductase Type II that converts testosterone to dihydrotestosterone (DHT) in the hair follicle. Finasteride causes a significant drop in both scalp and blood levels of DHT. So it can definitely help your native hair. Will it help transplanted hair which comes from the safe zone? I am not sure about that. Hair follicles in the safe donor area do not have receptors to DHT. Which is a metabolite of the male hormone which when combined to the receptors shuts off the blood supply to the follicle killing it. So from my understanding, safe zone follicles should last for life even without Finasteride.

    Hair Restoration Procedure Failing....

    in Hair Restoration Questions and Answers

    Posted

    Without clear pictures of your pre/post hair transplant it wouldn't be fair to judge. May be you have lost more native hair since the transplant? Or may be your donor hair was removed outside of the safe zone? Hair follicles in the safe donor area do not have receptors to DHT. Which is a metabolite of the male hormone which when combines to the receptors shuts off the blood supply to the follicle killing it. If safe zone follicles are used as donor, it should last for life.

    My experience with Dr. Tejinder Bhatti, 2364 grafts by FUE to restore hairline

    in Hair Transplant Reviews

    Posted

    Have a look at this post from Dr. Bhatti

     

    Hairline Design:

     

    Hi Blake and members of the Forum,

     

     

    When I was undergoing training in aesthetic plastic surgery, my professor and mentor Dr Ian T. Jackson (Southfield,MI,USA) used to often say- “Crazy doctors operate on crazy patients!” I could not help but it has stuck with me throughout my practice and now that I am in full time hair transplant practice, this caution reflected in the conservative hairlines I once routinely liked to do.

    It is not that I am not open to discussion and meeting patients’ needs if they are within esthetic guidelines and norms. However since I first joined the forum criticism has mellowed me down a bit and I am less likely to be so persuasive as I was earlier of strictly observing the “Rule of Thirds” and designing hairlines to suit one’s racial characteristics only. It is a global village now- a patient (of Indian ethnicity) who came in from Birmingham and who is a professional singer in an African band wanted me to do an African straight hairline with clear geometric transition points. Now see what I did. I would never have done this 2 years ago. The patient after 5 months is elated!

    (see pictures- the first picture in sunglasses is with a masking paint he wore before the procedure!)

    Also see this client for example who received an SMP procedure at a novice clinic and when he needed a hair transplant, I had no choice but to place the hairline along the SMP hairline since he was getting married in less than a year!

    (see pictures)- details will be posted tomorrow when I discuss Body Hair Transplants and my philosophy- my pet topic.

    This said, I have rarely had to counsel a past patient with a ‘conservative hairline’ returning and wanting his hairline lowered when the hair have fully grown. However hairlines can also be lowered with minimal grafts thus-

     

    If any clinic has a green thumb, it has won more than half the battle since a head full of hair is the first objective always and every time. Hairline design is important but there is more esthesis involved in this than are any important technical considerations. The final hairline should dovetail so wonderfully the esthetic judgement of the doctor and the desire of the patient while keeping in mind realistic long term goals without throwing caution to the wind. I will never do a low hairline which is less than the length of the nose and which does not have temporal recessions in the male. As a word of caution to some and solace for others, I never forget to tell each one of my patients when we are at hairline design- “you can never set back a wrongly placed hairline but can always move a high hairline down.”

    This is my usual hairline and it is criticised all over the forum by a few members but whom I respect for their constructive criticism. If there were no critics in this world, how would one introspect, improve and remain competitive?

    (see pictures)

    I agree that I have done some harsh hairlines before but the patients had extremely low single yield which is common in Indian clients. In such cases you can soften the hairline using chest hair but then there is the limitation of budget since body hair is expensive. You can examine one of my earlier harsher hairlines in this video-

    https://www.youtube.com/watch?v=reWY3RasPv4&feature=youtu.be

    However the patient was getting married in 6 months time and he did not feel any difference. The result seen is after 6 months of the procedure.

    For hairline design I observe a few yardsticks rather strictly-

    1. Is the patient psychologically stable to decide on his hair line? If the patient is stable and the hairline requested is within laid down norms but I think it is not suiting his face I will advise him accordingly but if he insists I would take his signature on a photograph with his hairline for future record. Many a patient can turn back and say many years later when they are older and mature in thought- “Oh Doc! But you should have told me so!”

    2. Has he done his research well? This is mostly the case with patients who have been on one forum or the other- especially the HRN, BTT and Hairsite.

    3. I make it a point to give the patient ample time to make a considered decision regarding hairline design and placement. This is done 4 times-

    (a) Online or in-person consultation wherein I first ask him to try and draw his hairline himself. Thereafter I draw one which I feel suits his face. Usually a compromise is reached midway if it is a young patient. Patients above 30 years usually ask the doctor for his advice! The patient then is asked to click pictures of the hairline since memory regarding hairlines has been found to be very short term in my practice!

    (b) If the patient has not had to the chance to come for a in person consult, he send in his pictures which are marked and sent back. We then try and reach a mutually agreeable hairline and this is locked.

    © The second time is the day before the procedure so the patient can mull it over one full evening before he turns up for the procedure.

    (d) The 3rd instance is the last time- he has to finally commit to a hairline design. This is on the day of the procedure before trimming is done. Measurements are taken and photographs clicked for reference during the procedure.

    (e) The 4th time when the patient can give only ‘minor’ suggestions is when he is turned around after the harvesting is complete, before slit making. However at this point since the hair has been trimmed down and there are no landmarks to relate to, taking the patient’s advice can be detrimental to the whole plan. The patient is not encouraged to make any major change. Measurements are compared to the pictures taken before the hair were trimmed.

    Though not dogmatic about it I am of the firm belief that patients’ objectives and goals keep changing with age. I have seen many a patient regretting getting a lower hairline at 25 years many years later when the balding has proceeded to an extensive stage and not much donor area has been left. With experience, I have learnt not to fall into the “20s trap” when the patient (mostly in the 20s) starts to hard-sell his home-made low hairline design!

    If there be any questions you may have for me, I would be pleased to answer to the best of my ability.

     

    You can find it here with pictures: http://www.hairrestorationnetwork.com/eve/175737-potential-recommendation-dr-tejinder-bhatti-chandigarh-india-14.html

    Scar Repair FUE Dr Jose Lorenzo Farjo

    in Hair Transplant Reviews

    Posted

    Hi Pepe,

     

    Thanks a lot for the reply. Appreciate it very much.

     

    May I pls know, are you on any meds? If so, since when?

     

    I am just trying to understand how/why HT's fail. I've always thought that hair in your safe zone is safe, as it is genetically resistant to DHT. If the grafts survived the HT procedure, it should last as long as the remaining hair in your safe zone??

     

    There is another guy on this forum who says he had 3 FUT's and all seems to have failed. I am waiting for his reply to the same question.

     

    Thanks a lot once again.

    Scar Repair FUE Dr Jose Lorenzo Farjo

    in Hair Transplant Reviews

    Posted

    Peperoni,

     

    May I please ask you, how many FUT/FUE procedures and how many grafts did you receive before this surgery? What happened to those grafts? All failed? How long did those grafts last? How did you lose them? Do you have any pictures from those surgeries?

     

    Dr. Lorenzo is the best. I am sure you will have good results from your recent procedure. All the best. Thanks.

    More and more posters hell-bent on going to non-recommended surgeons?

    in Off-Topic Posts

    Posted · Edited by JohnGage

    Lets do a comparison with the recommended "affordable" 2 Turkish docs and 2 docs who are not.

     

    For 3000 FUE grafts:

     

    Dr. Koray Erdogan: Euro 7,500 (USD 10,202)

    Dr. Hakan Doganay: Euro 6,000 (USD 8,161)

     

    Dr. Erkan Demirsoy: Euro 3,000 (USD 4,080)

    Dr. Tejinder Bhatti: Euro 3,087 (USD 4,200)

     

    Dr. Demirsoy and Dr. Bhatti are not the most economical. But they have lots of excellent results all over the web, including this forum. Someone like Dr. Maral would charge just Euro 1800 (USD 2,449) for 4000 - 4500 FUE grafts. That's including airport transfers, hotel stay and breakfast.

     

    For some of you who can afford it, I guess it's just not easy to understand what this means and how much of a difference it makes!

    More and more posters hell-bent on going to non-recommended surgeons?

    in Off-Topic Posts

    Posted

    I agree with densedream. A lot of people cannot afford these recommended doctors! So they look for cheaper alternatives. I am sure most FUE patients would prefer Dr. Lorenzo, but how many can afford him? Both Dr. Bhatti and Dr. Demirsoy are a lot cheaper and have shown very good results. Yes most of the recommended doctors here are good. But does a recommendation and/or a higher price automatically guarantee the best outcome? Do your research, there are so many examples on this forum. For someone who can afford it, price should not be the overriding factor when deciding a surgeon. But for others price may be the most important deciding factor... and then there are others who'd just say: Why pay more when there are surgeons out there charging much less and achieving equally good results?

    Rogaine/minoxidil sexual side effects?????

    in Hair Loss Drugs

    Posted

    A new type of topically applied drug (minoxidil) to facilitate erection is presented. Minoxidil acts directly on arterial smooth muscles via relaxation. This drug (1 ml. of a 2% solution) was studied under strict laboratory conditions in a double-blind controlled trial on 33 patients (4 with neurogenic plus arterial, 10 with neurogenic and 19 with arterial impotence) and compared to placebo and nitroglycerin (2.5 gm. of a 10% ointment). The application sites were the penile shaft (nitroglycerin) or glans penis (minoxidil and placebo). Increases in diameter and rigidity were measured with the RigiScan device and arterial flow was evaluated by conventional Doppler sonography. Side effects were considered as well. This drug proved to be more active than nitroglycerin and placebo in increasing diameter, rigidity and arterial flow of the penis. The highest activity proved to occur in neurogenically impotent patients. Fewer side effects also were found with minoxidil than with nitroglycerin. For these reasons minoxidil is proposed as a long-term therapeutic agent for organic impotence.

     

    Source: National Center for Biotechnology Information

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