CuriousJungleGeorge

In my opinion, "written guarantees" of yield don't mean a damn: good luck demonstrating a certain percentage of transplanted hairs did not grow. Sure, surgeons sometimes claim they'll "toss in, free," during a subsequent procedure, however many follicles did not come in, but not only would you be unable to make any such computation, the only way you even theoretically could cash in on the offer would be by paying for a new surgery, just with the slim hope of getting a handful of free implants.

I wonder, with Aderans's research, as hairs would be transplanted to see if they grow, would it be a serious concern whether the surgeons be competent at properly implanting grafts (i.e., at proper orientations)? Guinea-pigging yourself for a study like this might seem like a good idea, but if you do grow hair that's aimed the wrong way, you'd probably need to undergo a (paid) revision.

First, you have no proof Arjun Rampal underwent hair-transplant surgery. I say this not as some blinded, raving fan, but it's important to note this after you quite unequivocally state he has.

Second (on to you), I don't know it would be wise to get a hair-transplant simply to lower your hairline. This isn't because it's "silly of you to want to" (any cosmetic procedure could be called silly by a third party), but because you might go on to lose a significant amount of hair, which could then become difficult or impossible to replace. If you're unlikely to lose hair (i.e., you've not started to; your gene-pool does not indicate baldness; etc.) (and, even then, it's a gamble), you might consider it, but if your notion has stricken you largely because, as you look in the mirror, you find yourself with less hair than you had not very long ago, having performed a procedure to restore a "juvenile" hairline may not work for even a short while (by the time the transplant grows in, you might find you've lost too much behind the work to have likeable results — and thus it may continue, ad infinitum).

Hi. This question is from interest, not from desire to research "my options": I've noticed certain surgeons design (with eye-liner) quite rounded hairlines, whereas others use a very jagged pattern; yet, often, the results from either yields perfectly natural results. So, is this simply because those who draw smooth lines don't actually transplant grafts in that pattern, or is something else going on?

Thanks.

One wishes this sort of possibility were raised by physicians during initial consultations. A lot is said about fine scars and the "gold standard" of follicular-unit transplantation, but things like bad direction and nappiness tend to be completely forgone from the conversation.

Originally posted by Time to do something:

I had very low growth on my first HT. Because of that the doctor did a second one free which also produced very low growth. I had the first and second procedure checked by other doctors who agreed for the amount of grafts I was supposed to have had it was not close to where it should be. I complained long after the second HT and indicated that the results were as poor as the first HT. I requested a partial refund and was denied the request. The doctor said he did not know what I was basing a request of a refund on. I told him it was lack of growth. Dr. Shapiro learned of my unfortunate situation, felt sorry for me and offered a free procedure which was done in November. I already see hair surfacing and it hasn't even been three months yet.

Do you believe it was poor work done by Dr. Epstein that resulted in bad growth, or that the outcome was simply from ill luck?

Also, do others feel, in a case such as Time to Do Something's, the physician should have offered a refund (even if only partial)?

If the results of a procedure are not good, is it the physician's responsibility to remedy them at no additional cost to the patient; or is the patient expected to understand and accept there are no sure things in this kind of treatment, and that further work will have to be paid for?

(This thread is not composed out of frustration with any doctor; I simply wish to read what the general sentiment is around the topic.)

Speaking of shoe-polish, is it really much inferior to other "painting" products?

Both products seem to be about the same, is this right?

Also, does one need the bottle for the fibers to work? That is, will the product work if you pour the fibers from a small bag or something, rather than from the original bottle?

Would static electricity (e.g., as generated by pulling a sweater over the head) dislodge all the fibers?

Thanks.

Any opinions? Is Nanogen better than Toppik?

Is this the sort of transplanted hair that would eventually fall out, or the kind resistant to thinning/loss?

It's hard for anyone to say, from that single photograph, whether you're balding or aren't. For one thing, no one knows how your head looked a few years ago ??” not everyone has a great deal of natural density. If you're concerned, you should speak to a doctor (your P.C.P. ought to be all right, for this), and, if it seems reasonable, try medication.

Good luck.

Originally posted by ukjoe:

CuriousGeorge:

 

The "cover is ass" comment was regarding him lying to me about his assistant missing the removal of sutures followed by his explanation of ethics, and nothing to do with his actual stance on prescribing medication. You apparently missed that part...

 

As for "To prescribe medication "off-label," for a physician, indeed is an "ethical issue". Physicians have been prescribing and pharmacies have been filling off-label\generic medications ever since I can recall... I'm not sure if there are any laws that look differently upon whether a medication is for cosmetic purposes or not so I have no idea where you are going with this...

 

 

As for your next accusation..., I accused him of nothing. I merely speculated about how his motives could appear to others. Especially as it sharply contradicts the FDA. Does he have stock in Merck? I don't know nor do I care. Nor am I annoyed about his stance. I have great respect for Dr Reese and his practice. But no more than the other Doctors who disagree with him. My audacity to question a Doctor really seems to stir the pot for some...

 

What I was annoyed with, as I will repeat for the last time in this post, was his failure to be up from with me about the sutures not with his stance on Propecia.

 

It is amazing how quickly these forums can digress.

I wasn't quoting you when I said "cover his ass" ??” just giving an example of a reason for which he may refrain from prescribing medication off-label.

"Off-label" prescriptions have nothing to do with "generic medication" (not directly). Yes, doctors often do prescribe drugs off-label (i.e., for uses not approved by the F.D.A.), but whether or not to do so is a moral concern for one. As for this specific medicine's (finasteride's) being used cosmetically, I only mean to say, it isn't being prescribed for a life-supporting purpose, which may make a doctor less willing to prescribe it in the "off-label," arguably shady way.

You did accuse him of something when you "wondered" "who" owns stock in a pharmaceutical company (Merck): the accusation implicit is he is persuaded from financial gain not to prescribe Proscar off-label.

I don't feel your "audacity" (I don't see it as such) to question a doctor has "stirred anyone's pot"; simply, some of the things you said in your initial post have ended up feeling unjustifiably accusatory. Now, if you felt the doctor wasn't being up front with you about the sutures, fine; if he wasn't, he was wrong not to. Even if he was, it's wrong you were sent home without every suture's being removed (it's possible, but not really "OK"). If this was your main point, I agree, the thread indeed has digressed terribly.

Originally posted by ukjoe:

I'm not sure what you think Dr Reese is right about in my original post. There has been a lot of confusion in many of the responses in respect to my original post but I know these boards go off in many tangents. A few of you are citing insurance fraud which is not an ethical dilemma but a legal issue. My Dr prescribes finastride for me. It isn't billed as something else other than for the DX of alopecia. It's not covered by my insurance and we are not trying to fool the insurance company. I pay out of pocket 100% so there are no legal concerns. I explained this to Dr Reese but it is what it is I guess.

 

Also there is a lot of mention that there is no generic drug for Propecia in this post and from Dr Reese. The FDA clearly labels finastride as a generic drug for Propecia. I'm not sure what other definition of "generic" one would reference for a drug other than that of the FDA.

 

As for Dr Reese, I have no argument with him at all. Ethics are a grey area. Some border on legalities and some do not and these are choices each and everyone of us must make and I respect his decision. I completely disagree with it and by his reasoning; the FDA does as well so it just doesn't make sense to me.

 

This kind of reasoning could make one wonder who does and does not have stock options in Merck...

To prescribe medication "off-label," for a physician, indeed is an "ethical issue"; you can drop it into the box of "medical ethics," if you must, but indubitable it falls into a philosophical category. Some doctors (i.e., some people) are more "practical," and may write for you a prescription such you can better afford a drug; others may feel it is wrong to steer from a more stringent path.

Let's bear in mind, this is a cosmetic issue; we aren't talking about expensive meds. you need to stay alive. If Dr. Reese will not prescribe for you a drug off-label ??” to "cover his ass," to stay within his moral zone, for whatever reason ??” you can be annoyed, fine, but it's certainly odd of you to accuse him of immoral conduct (even in this more recent post, you imply he benefits financially from not prescribing generic finasteride in place of Propecia).

Precisely what causes transplanted hairs to fall out shortly after the procedure?

Thanks, Bill, for your complete (and promptly delivered) reply. Based on what you've said ??” I hope you don't mind my saying ??” I feel the term "ultra refined follicular unit grafting" is a bit misleading, or at least unfair. From the information you've provided, it seems the alternative to this technique (i.e., using "chubby" instead of "skinny" grafts) is equally valid, and is simply preferred (for scientific, not financial, reasons) by some doctors. Until I read your post, I was under the impression "skinny" was better, based only on the term "ultra-refined" (which just sounds superior to anything it's up against).

Originally posted by thanatopsis_awry:

Why don't you read the actual thread that you choose to speak on, CuriousGeorge, before you make sweeping statements and guesses that malign the very people who have:

 

-- actually spent the time to promptly give the OP support and guidance, in this thread and behind the scenes

 

-- actually spend the time to educate people who may fall prey to the very, overarching situation which the OP unfortunately fell into

Read the thread, Thanatopsis_awry; found the overwhelming percentage of responses to be impertinent and demoralizing. Posted my reply. If you take umbrage or feel what I've said is inaccurate or plainly wrong, so be it; I stand by every word.

This Web site names thirty-four coalition doctors and recommends twenty-three more who are not "coalition members." This has me raise two questions:

1. What distinguishes a "coalition surgeon" from one who is simply "recommended"? The site mentions the former must have "demonstrated capability to successfully perform large sessions of ultra refined follicular unit grafting using tiny incisions and grafts that are microscopically prepared" and show "the ability to dense pack tiny follicular unit grafts in a given area when appropriate" (http://www.hairtransplantnetwork.com/Consult-a-Physician/our-hair-restoration-physicians.asp). But, shouldn't any competent physician, in this age of the technique, be using "tiny incisions" and preparing grafts "microscopically"? I'm under the impression slicing up grafts using a simple magnifying glass is too primitive to allow one to be recommended.

2. Are those doctors who're constantly discussed in this forum measurably more reliable than those who are not? Of the thirty-four aforementioned surgeons, only a handful have a constant and potent presence in these threads. Dr. Feller comes instantly to mind. Should a potential patient, then, believe Feller's (not to pick on him) work or method is any superior to, say, Gabel's (not shilling, I promise ??” just an unfamiliar name picked randomly).

Thank you.

This post is in response to the original poster's initial concern. You say it's been about eight months since your procedure (or has it been ten, now? Sorry about the confusion), and while I can understand your angst, worry, and frustration with your results, understand they may very well not be your "results": It takes time for a transplant to "come around," and, at eight months, there's some left in which things can improve. I think it's unfortunate no one in this thread, really, has yet said anything to this effect (not even Bill, the moderator); no doubt your mentioning you were treated by Dr. Armani got everyone up in a fury, and neglectful to point out this detail. Where you are now, you might have been regardless of who worked on you, had it been Armani or the ever-exalted Dr. Feller. Give it some more time ??” see how things look around the end of the year (2009). I'm not saying nothing's wrong (I'm not a physician, and, even if I were, I couldn't [no one could] make a definite assertion as to the failure of your treatment based on a few photos seen over the Internet), but I am saying it might still be too early to tell if anything is. Don't lose all hope just yet.

Hey, everyone, by the way, again, way to calm the worries of this person. There's been talk of head-shaving, wigs, lawsuits; there's been back-and-forth about accounts that haven't been active for years; people have quickly unbuckled their long-fostered hatred for a surgeon; and no one's bothered to make this guy feel better about his situation. How would the folk in this forum have responded had this thread been begun by a patient of a well-respected "coalition doc.?" Before a range of offended typists unleashes the predictable and "exonerating" evidence of Armani's "history," realize that isn't my point. Mightn't it be nice if already emotionally-wounded people who come here for support and guidance received more than just a bunch of bitterness-born bias?

Originally posted by Dr. Glenn M. Charles:

I recommend you at least wait 24-48 hours before wearing baseball cap. You want to make sure that there is no oozing from the grafts that could potentially stick to the inside of the hat when you take it off. You should use a clean adjustable hat and attempt to put the front on first and the back of hat last. How many hours a day you wear it does not really matter. I do agree that you should wear the hat if you are going to be exposed to the sun.

If you wear a cap right after the procedure, and a few grafts are pulled out, can the rest be OK?

Thank you, Dr. Simmons.

Strip-excision is an older method than F.U.E., but that doesn't imply it's outdated or inferior. Each procedure has its advantages and its limitations, and it's certainly unwise to consider a physician to be archaic simply because he or she offers both options (in fact, I'm almost sure no respectable surgeon will offer only F.U.E., as the method, again, has its limitations).

Still no responses from physicians...?

From what you've said, I don't think anything was done "incorrectly" in your procedure. It's normal to lose hair in both the donor and recipient regions; transplanted hair often can come in coarse and awkwardly, at first (allegedly, this improves over time); patients sometimes use concealers to hide spots on their scalp (it's not your doctor's fault that Toppik didn't look good on you).

I hope your results are better by now, and I certainly accept you might have been subjected to bad work, but, from your recollection of your experience, I can't say it sounds as if you definitely were.

Looks OK in the picture, but, hard to tell from the single angle.

*By the way, it isn't a "scar," yet ??” .