Speegs

There a ton of crappy doctors who have ISHRS certificates, check their list, freakin' Dr. Bosley and about half a dozen MHR breakaways are "certified" by them.

I know nothing of him but here's his site:

 

http://www.fisherhaircenter.com/

Its an actor wearing a piece.

Nizoral is pretty effective in stopping scaling, use it a few times weekly and your itching is likely to stop along with visible scales. Mild dandruff may continue but it will more powdery than flakey and not itch.

No, you're right to throw caution to the wind, it is an expensive and huge cosmetic commitment and must be approached with realism.

 

And often the draw backs are downplayed on this site, too many behave as if only places like Bosley are capable of screwing up or scarring you.

Originally posted by cautious:

Thanks TC17 & Speegs,

I'll keep you posted. Unfortunately, there are not a lot of pictures of Dr Pathovamics work either & they are really the two Dr's that are closest to me outside of australia (and whos prices are reasonable). I really dont want to shave my head either so that cuts down my options regarding hasson & wong etc.

Aska, have you got a weblog about your experience with Dr Tykocinski or any pictures that you would be happy to share?

Thanks

Be patient and picky, I understand you wanting bang for your buck, perfectly reasonable and the Australian dollar probably matches up favorably against the Brazilian Reias and i expect there is probably near parity between the Canadian and Australian dollar, likewise American surgeries will be more expensive because of the exchange rate that places the American currency as a stronger one, same too if you sought EU doctors.

 

Dr.T is recommended by a lot of sites but that doesn't mean hes for you personally, only you can decide. Check out a site called IAHRS, many of the doctors on here are on there as well and you can research them from a consumer advocacy perspective, chances are if a doctor is on here and there, but especially there then they have a good track record of patient satisfaction.

I've never met a patient of Dr. Barrera but i know he is very pricey.

 

That and the fact there are less expensive and just as good if not better options in state and out would be reason enough to research further in my opinion.

Originally posted by cautious:

thanks everyopne.

I have emailed the clinic so hopefully someone who speaks english will get back to me. I am in a similar boat with Dr Pathomvanich where there arent that many pictures posted. Certainly the ones posted of Dr T's work look really good...just hoping thats a decent representation of the type of work he always does.

thanks

His consultant Leo will likely let you see his personal restoration photos but brazilian law will keep him from letting you see any more of his patients. Leo is like a class 5 bald class so if you were looking for a less aggressive pattern and how he dealt with it I'm afraid beyond what you find on this site Dr.T remains a bit veiled in available photo evidence of his work.

There are lots of doctors in Texas who are full time hair transplant surgeons, its the primary function of their practice, always seek them before a general plastic surgeon who does tummy tucks one day and strip surgery the next as the exclusively hair oriented physician will be more experienced.

 

Depending where you live I am not uncomfortable having you consult with the following three Texas doctors as i think they are ethical and all share the same board certifications and consumer advocacy vetting by IAHRS, a consumer watchdog organization that is very particular, some doctors that are on this forum aren't even in it and this forum is particular as well.

 

In Houston Dr. Berardo Arocha has an MHR fellowship background and a private practice in River Oaks and Dallas. He's definitely the most expensive quality physician in Texas but the other two are not inferior to him.

 

Your other options are to drive to Austin to meet Dr. Dan McGrath who is a hair transplant patient himself , he too was a surgeon at MHR in San Francisco and Newport Beach for many years, he is more conservative in his graft estimates than Arocha and a dollar less per graft.

 

If you chose to go to San Antonio you'll find Dr.Limmer who is by far the most tenured hair restoration surgeon in the state, at least that hasn't garnered a bad reputation, he's conservative in his approach but very experienced and a slightly less than even McGrath.

 

So depending what you need it may be more budget conscious to go to Austin or San Antonio, I recommend you consult with all three, i have, still haven't made up my mind but those are the best three options in the state.

Originally posted by Mop:

thanatopsis_awry - You make some really valid points in your response. Many things are subjective as you say.

 

Leeson - looks like you are one step ahead of the game already - just wondering the difference between not happy and negative ?

 

I guess what I think the scoring system should be is an agregate of various criteria. It would be good to benchmark for comparison, using my criteria (a) to (g) above with a big weighting on final result, then we could say ( hypothetically ):-

 

a) Doctor A based in New York, 156 results posted in last year, average score 9.0

b) Doctor B based in Seattle, 78 results posted in last year, average score 8.1

c) Doctor C based in India, 55 results posted in Last year, average score 8.8

d) Doctor D based in Alaska - 63 results posted in Last year, average score 5.6

 

Whilst A,B,C would indicate high standards and results - you would avoid D ! Even if he has posted a few good results, is a member of the coalition, member of ISHRS, has a great CV and impressive website.

 

Just an idea, I am day 7 after my HT ( happy so far ) and obviously alot of time on my hands in my personal downtime !

Well its obvious that Dr.D has to keep follicles from freezing and must thaw out the donor area prior to surgery. Arguably the graft survival time outside the body is greater

 

But the clinic is under constant duress from polar bear attacks thus plummeting the customer service rating.

Originally posted by arnolder:

I'm fagging around 10 cigs. a day from 10th day post-op onwards, I don't know what impact will it make on my hair growth....

LOL at terms lost in translation, we are divided by a common language.

 

Smoking probably isn't the healthiest thing for blood circulation, I can't say it is hurting your hair but I know it isn't helping it.

Originally posted by Bill - Associate Publisher:

Speegs,

 

I'm not sure how many photos you're looking for, but I'd hardly call the 16+ cases on his profile scarce.

 

See Dr. Tykocinski's patient results in his hair transplant patient photo gallery.

 

Best wishes,

 

Bill

I want to see loads of pictures in my baldness class, I want to see a best case scenario and a worst case scenario, I want to see how his megasessions turn out.

 

I want to see how he handles those in my age range, there aren't any 25 year olds in his porfolio on this site. I want to see it, if i don't see it i am not going to blindly pay to fly to Brazil and have someone cut a chunk out of my head without any clear expectation of what to expect when he's done.

 

Not trying to be disagreeable, I'm just very thorough and picky, one scalp and if i can help it one procedure to hold me off from more until my youth is passed.

Sorry to here of this friend, personally i think Dr.Armani is a bit ethically questionable as he is willing to dense pack absurd numbers which runs the risk of scarring and prayerfully it is not the case in your instance, I sincerely mean that. Be patient but document your progress, if the unsavory bumps persist you might want to report Dr.Armani to the California or Canadian Medical Review Boards, they don't take malpractice with surgery lightly and will investigate your claims.

Originally posted by Marvin:

Bald men have always looked less intelligent to me. I think it's an innate thing for me to see baldness that way, as I've continued to assume that bald men are less intelligent even when I realized I would eventually go bald, and even when I started going bald.

 

This is obviously a major reason why I am at this forum trying to do something about it.

That's an interesting comment that runs some what antithetically to historical perception of balding men, typically they are deemed wiser since the condition is associated with age and experience.

 

I must concede that on some men a slight recession is cosmetically appealing and actually looks rather dignified and distinguished, even on a younger age bracket, assuming the man as a whle is full of character and charm, our hairlines can take on personalities and I think that's due to self and not the hair. We cripple ourselves when it is the hair that dictates personality.

i think alot of the stigma comes from two sources, one being the vanity of non hairloss sufferers and two the poor quality of most hairloss remedies such as comb overs, toupees, wigs and plugs.

 

It is especially psychologically impactful on a young man, particularly those 30 to 18 as it effects their appearance more dramatically than other age groups and gives them the stigma of "premature aging" although it is an asinine comment because hairloss is not age specific and can effect anyone and any time with a genetic predisposition to it.

 

Unfortunately youth is known for its vanity and so youthful men afflicted by the "premature aging: stigma are particularly subconscious and feel socially wounded whether true or not.

 

Personally I have never condescended to follicularly vulnerable men, probably because the genitc predisposition was in my family and I knew what goes around comes around, yet as much as I am not judgmental of hair loss in others i am uncomfortable having to deal with it personally, its a personal dilemma for every man.

 

Some men press on hardly deterred my it and accept it and adapt with it gracefully, others understandably find it unacceptable and look for ways of mitigating the damage.

 

The expense of cosmetically catalytic procedures such as hair transplants and good systems often keep budget minded men, particularly young ones, from investing or investigating into seriously pursuing one.

 

Ultimately hairloss is a draw back cosmetically that all men deal with differently but ti is a health concern to all because of scalp vulnerability to sun damage and it is an expensive one to remedy in an aesthetic sense.

 

So it possesses few pluses beyond hair cut expenses.

Originally posted by arnolder:

Is it really necessary for the grafted hair to fall off within a month? Its been 5 weeks for me now and I still have like 20-25% of grafts on my head.

After 4 weeks I started to massage the transplanted area with shampoo and then spraying over the area with some force so that the hair sheds.Am I wrong somewhere? I've read new growth will only start once the grafted hair fall out.

Some people heal differently and see grafts stay and growth immediately, but its exceptional and not normal, consider yourself exceptional and hopefully it is a sign that the whole procedure will share that distinction as a face framing restoration.

I've consulted now with 9 doctors.

 

Dr. Arocha 2500

Dr. Puig 1400-1600

Dr. McGrath 1500-1700

Dr. McClellan 1500-1600

Dr. Limmer 1500

Dr. Tykocinski 2500-3000 (via pictures)

Dr. Epstein 1800 (via pictures)

Dr. Keene 1500-1800 (via pictures)

Dr. Rahal 3000 (via pictures)

 

Six of these doctors are on this very forum and a seventh (McGrath) along with those six is certified by every reputable board and consumer group monitoring the industry today.

 

Four of those seven doctors are recommending less than 2000 grafts, the other three are recommending way more aggressive approaches. What's a man to do?

My only qualm with researching Dr. t is the scarcity of patient photos. There are some on this site but unfortunately you can't request to see more because of brazilian law, that's a point of hesitation for me.

 

I don't doubt he's good but i want to see a plethora of pictures.

Originally posted by hair_care:

1800 grafts spread out over such a large area will not give you much density. Nevertheless the work looks all right so far. Keep posting updates.

Not necessarily, sometimes less is more, if the doc was at least 35cm2 to 45cm2 it will be aesthetically passable and since he has dark skin, dark thick hair and a wave he will get better coverage than a fair skinned, fine haired candidate with the same pattern of loss. If this doctor knows the tricks of graft positioning and depending how much hair was harvested in the grafts, 1800 can do every bit the cosmetic job 3,000 grafts can if done properly and without graft dissection.

 

Often the 3,000 graft cases use a lot of one hair grafts or load cm2 up with more hairs than required for an aesthetic difference, meaning you really don;t discern much better cosmetic gain from packing over 40cm2 to 50cm2, it can be wasteful in some instances to do more.

 

Now he'll have plenty of donor which he'll definitely need if he refuses to do finasteride.

 

He realistically has 6 to 7,ooo grafts in his donor and without medication protecting his crown and top if he had used half of his donor on one third of his scalp he would be doomed to live with a bald crown at the least.

Isn't Armani the man that uses nothing but FUE and encourages everyone to dense pack absurd numbers of graphs?

 

It sounds as if FUE may have damaged your donor area, I've heard of it doing as much, even in the hands of men so well versed at it as Dr.Cole.

 

I'm not a medical mind so i don't want to needlessly alarm you but it sounds like you need to keep an eye on it, you may not be able to wear your hair that short anymore.

Originally posted by the B spot:

I just want to point out that mega-sessions and density are two different issues.

 

For mega-sessions, the issues are the time grafts are outside the body, handling of grafts, donor tension, and future progression.

 

For density, the issues are graft survival, proximity, scarring/ridging and future loss behind the high density transplant.

 

Additionally, densities are not all the same--50 fu's of 1+2 hair grafts is not the same of 50 fu's of 1+2+3 hair grafts, so do not be so quick to discount 40-45 fu's in a given sq cm--look at the graft and hair count to determine the actual density.

 

You must look at the patient's hair characteristics as well... patients with thick, coarse hair when transplanted at 45--look like 65, other when transplanted at 45 look like 35 all due to hair characteristics.

 

All things considered, Dr, Shapiro does 40-50 on a regular basis, and occasionally will exceed that for a select few patients. However, we have seen that in almost every patient, the need to "selectively tweek" a hairline or temples results in a 2nd HT--almost ALWAYS--based on that, there is no need to push a higher density--we can then use a minimum # of grafts to truly make a result spectacular, without being beholden to specific # of grafts.

(If we do 50 first time, then add 10-15-20 in areas that the patient and Dr. Shapiro feel necessary, the result is great, without doing too much in a given area)--ie--the patient would notice no difference btw 65 or 80--so 65 will meet the patients goals.

 

There are other schools of thought on this, but our results are proven. We want to maximize every graft, use the minimum # of grafts to attain the desired result, while always keeping an eye on future loss.

 

On another note--I want to point out that a particular doctors methods are exactly that his or her methods---no one is forcing anyone here to go to a particular clinic--for those doing research the ultimate test is seeing patients in person--that will erase any doubts as to whether a doctor is for you or not for you.

 

Additionally, while cost is a factor, it is not the only factor--if you narrow your decision to 2-3 doctors, then weigh cost vs travel vs comfortability.

 

Take Care,

Jason

You are correct to note megasessions and density are separate issues but when dense packing someone with mild to moderate hairloss they do seem to become twin concerns because typically dense packing calls upon a megasession which will require a third if not half of a patient's donor supply which is what 2500 grafts represent on me since I'm estimated to have a donor area that can yield 6000 to 7000.

 

So one must weigh carefully from many different voices what is safe and reasonable to do at one time. That doesn't discredit the value of megasessions and dense packing, but it does caution that they aren't infallible and risk free methods.

Originally posted by Ron J:

The irony is so dense it could cause complications.

 

I routinely see Ultra Refined results from Coalition Members: Rahal, H&W, & Feller that include both mega sessions -AND- dense packing at 50+ grafts cm/2. But, I have yet to see any of the complications arise from these good dr.'s that Dr. Limmer states as clear medical facts. I just wonder if Dr. Limmer has personally experienced these complications; has seen them from any of the dr.'s I mentioned above, or he can't dense pack as they do w/out resulting in such complications?

It would appear the some doctors are simply ultra protective of grafts and donor supply and do not want anything left to chance as dense packing over 50cm2 can cause. It also seems that for many 40cm2 will be dense enough for a satisfying illusion so they don't want to waste further donor hair piling on to little cosmetic effect.

 

i'm still weighing the two camps but i certainly see and appreciate Dr. McGrath and Dr. Limmer's concerns.

 

What it really seems to boil down to on an unspoken level is patience, megasessions provide a little bit of an instant gratification allure and the more conservative density procedures make you wait a little longer to see a result, of course some people can be satisfied by a less than 2000 graft job and some may require another 1000 to 1500 a year later, where its argued that scalp elascticity returns and a competent doctor can return to the donor sight and reopen in without cutting a new scar into the back of your head.

 

It certainly is seductive to dense pack but the question is whether or not less is more in this instance, the jury is still out in my opinion, thus i am still weighing the pros and cons of the dense packing argument before any one touches my head with a scalpel.

Originally posted by Bill - Associate Publisher:

Ron and Speegs,

 

Ironically, Dr. Limmer's message isn't disputing the viablity of megasessions and in fact, isn't referencing them at all. Instead, he's referring to hair growth survival rates in regards to dense packing.

 

Leading surgeons in the field, including those you mentioned recognize that vascularity plays a major deciding role in how much hair should be packed together in a single session. How much a surgeon is willing to dense pack in a single session will also vary from patient to patient.

 

This topic was discussed at last year's annual ISHRS scientfic meeting in Montreal.

 

You can read more on this topc by visiting the Highlights of the 2008 Annual ISHRS Scientific Meeting in Montreal. I've copied that section below for your reference:

 

Dense Packing Complications

 

Large session high density hair transplants are desirable to patients since it typically limits the number of subsequent surgeries needed. And though a handful of leading hair restoration physicians have taken on this challenge when appropriate for the patient, some complications have been cited in a panel discussion led by Dr. William Parsley. Dr. Ron Shapiro and Dr. Michael Beehner shared their experience and expertise on this subject.

 

One debated complication is graft survival at higher densities. Previous studies have been done on graft survival rates that indicate graft survival decreases when density increases. Whereas just about anyone can transplant higher densities, growth yield is debatable.

 

The introduction of smaller blades to make recipient incisions has convinced many leading surgeons that higher densities may produce adequate growth yield, but not in all cases. Dr. Beehner believes that the staff's experience and ability to trim and place grafts safely into recipient sites plays major role in graft survival at higher densities. Dr. Ron Shapiro agrees but also believes that more scientific study is needed.

 

Other complications include increased risk of necrosis, "shock loss" to existing hairs, abnormal distribution of hair in the event the patient loses more hair, and using an abundance of a finite donor source in a concentrated area.

 

Most surgeons will agree that cases exist where extreme dense packing is suitable. But in many patients, lower density hair transplants are appropriate.

 

Best wishes,

 

Bill

So Dr. McGrath and Dr. Limmer are somewhat vindicated by this study. Both men are recommended by the ISHRS as well.

Originally posted by HairDew:

Speegs,

 

Or you can use Google's Picasa, its FREE

Of course it's not Photoshop but its great if you only need some basic functionality (resize, crop etc)

 

http://picasa.google.com/

Where's the resize function on this, i only have cropping ability on the tool bar.

Originally posted by aska:

Thats the thing, i'm 5 months out, i had some shockloss on the donor area and so far i still ha a minor shock loss, i can't cut my hair shorter because of this. The scar looks good, the thinning arround the scar is the problem.

Can i have any hope that it'll come back?

It's over?

Who performed your surgery? Contact them and ask.