Speegs

I've tried to upload photos and it says mine are to big, how do I downsize the KB to format the forum?

Sooo...hair loss, anybody got any of that, seems to be goin' around?

Originally posted by TC17:

While many people on this forum repeat the adage "don't let location be a factor", the truth is that location is a factor for many people. That is why Pat travels all over the world trying to find doctors in different parts so that you can receive a world class transplant closer to home. I've spent quite some time doing research and I like doctor's in Canada, Brazil, Europe, Thailand, and the United States. But, I can assure you that when I'm finally ready to take the plunge, I will be visiting a doctor closer to me. I see nothing wrong with choosing a doctor based upon location provided that he is equal in your eyes to a doctor located 2,000 miles away. Although post op complications are rare, I do not want to be far from my doctor in the off chance that some do occur. There is something to be said about being able to drive or take a very short flight to your doctor if the need arises.

 

Personally, I really like Dr. Arocha's work and believe that as he becomes more of a presence on this forum he will be mentioned in the same breath as the more popular names. He is a bit more expensive than the other doctor's though, and if cost outweighs your desire to stay closer to home then certainly look at other physicians.

 

Again, I think that location and price are factors to consider if you are comfortable with the work of the doctor. If you are only comfortable with a doctor who performs in Antarctica, I would say pack a coat and hop a flight, but there is nothing wrong with wanting to say closer to home.

Have you had any work done? Are you Texas based?

Originally posted by thanatopsis_awry:

Speegs, if you have any doubts about how amazing "megasesions" are -- and 2500 is *not* even a megasession -- just look at the 2500+ graft cases that get rolled out daily with the highest degrees of transparency and excellence by multiple clinics (H+W, Feller, SMG, et. al.).

 

Same thing for megasessions that involve "densepacking" -- Rahal, e.g. -- densepacks to awesome degrees and the density and result achieved is consistently magnificent.

 

The proof is in the pudding, the pudding takes skill, and not everyone can make it.

By the way your hair looks very nice, 3000 grafts your blog says. So 1500-2000 may well be enough for me as i am a little less advanced than you were before the procedure. Were you a 3a or a 4a preop? I'm a regular 3 at the moment.

Originally posted by thanatopsis_awry:

Speegs, if you have any doubts about how amazing "megasesions" are -- and 2500 is *not* even a megasession -- just look at the 2500+ graft cases that get rolled out daily with the highest degrees of transparency and excellence by multiple clinics (H+W, Feller, SMG, et. al.).

 

Same thing for megasessions that involve "densepacking" -- Rahal, e.g. -- densepacks to awesome degrees and the density and result achieved is consistently magnificent.

 

The proof is in the pudding, the pudding takes skill, and not everyone can make it.

I appreciate your opinion but i am looking for medical facts and opinions and not simply thumbs up enthusiasm from posters, i don't mean that disrespectfully, but i need more to look at then simply "trust me it works", I want the details of technique and how it is able to perform with greater result and without detriment to the grafts. I just want some clear answers on the matter.

 

For instance this is the opinion Dr.Limmer emailed to me, and he is a member of this forum and coalition:

 

While many patients can do fine with 50+ grafts sq. cm you increase the possibility of poor growth, prolong/permanent pinkness (neovascularization) and ridging (scar tissue formation beneath the grafted zone). Also, for many 40 grafts/cm2 is reasonable and decreases the risk of post op shock loss of existing hair.

Finally, with less risk you can always go back and do an additional pass if needed.

Those are not just my opinion, but also plain fact born out of seeing what happens with higher and higher densities of planting. Complications might not always occur, but when they do it is a problem. So I try to avoid this happening.

Brad Limmer, MD/jac

Originally posted by Dr. Bernard Arocha:

Speegs,

 

I always ask the patients if they want to stage the procedure in more that one session. Why would you want more sessions unless it is for budgetary reasons. Remember that over 70% of my patients achieve their goals with only one session if they have the recommended size procedure and treatment.

I forgot to ask, how have your derived the 70% number? I realize personal satisfaction and expectations are largely a personal taste and desire but I was just curious about how you know 70% were one and done so to speak, beyond the fact they didn't come back to you for a second surgery.

Originally posted by Dr. Bernard Arocha:

Speegs,

 

I always ask the patients if they want to stage the procedure in more that one session. Why would you want more sessions unless it is for budgetary reasons. Remember that over 70% of my patients achieve their goals with only one session if they have the recommended size procedure and treatment.

How do you prevent shock loss while dense packing in such a relatively crowded area that still possesses native hair? What do you think graft survival for your megasessions tends to be, say a 2500 case and what density cm2 do you favor in a hairline? How does one keep track of follicular unit growth, does he have to find a graft with an entire bulb to know that a graft fell out?

Originally posted by Dr. Bernard Arocha:

Greetings to all,

quote:

Originally posted by TC17:

You said that Dr. Arocha quoted you $10,000 to $12,000 for 2,500 grafts, but that is a HUGE difference in price. Which one is it? $10,000 would be a very good price, but $12,000 would be pretty steep if you ask me.

That's just what he said, about 2500 grafts and 10to 12K for the work depending what he did.

 

 

It's not so much what I did, as when I did it. We were running a special of $4.00 per follicular unit that month. The regular price for FUT through FUSS is $5 per FU for the first 2000, then $4 per FU for any over that at any time. Thank you all for your time and comments.

Dr.Arocha, respectfully since you are here, what is your opinion on graft survival in a megasession? Are you confident in the survival rate of a vast majority of a 2500 graft transplant in a region as small as a norwood 3? Many doctors feel there isn't room for that in a norwood 3 case and that you risk shock loss and graft failure, please advise us how you counter the 40cm2 literature without taking great risks to graft survival, because even if a doctor were to guarantee 90% survival rate that is a lot of wasted grafts in a 2500 session,10% non growth is 250 failed grafts x 5 dollars equals 1250 bucks down the drain and a fair amount of wasted donor supply.

I'm doing my homework milkman, doing it best i can, the reason I bring up McGrath and Arocha is they seem to have nearly identical backgrounds, credentials, certifications, societal membership.

So resumes are nearly twins but they both express a very different opinion about graft survival and I'm trying to see both their opinions. I think both men are ethical.

Basically I'm trying to decide if the argument to have two less than 2000 graft surgeries is prudent or if the more aggressive 2000 plus grafts is warranted (without killing grafts) at once. Yes one session is cheaper and aesthetically more gratifying in a shorter time frame IF the grafts survive but if you are running an unnecessary risk to their survival then it seems better to scale back a few hundred grafts and do it in two rounds rather than waste donor hair and money.

 

I'm discerning the merits of these two arguments and it will take time, I'm not married to choosing wither McGrath or Arocha but they represent the two main camps in contemporary hair restoration procedures.

Originally posted by irish-2008:

Must be the recession affecting everyones mood

A double meaning to that one, well played.

Originally posted by TC17:

You said that Dr. Arocha quoted you $10,000 to $12,000 for 2,500 grafts, but that is a HUGE difference in price. Which one is it? $10,000 would be a very good price, but $12,000 would be pretty steep if you ask me.

That's just what he said, about 2500 grafts and 10to 12K for the work depending what he did.

Originally posted by Dr. Timothy Carman:

Originally posted by Speegs:

Originally posted by Dr. Timothy Carman:

Marko-

Those photos are great. It would appear that (and granted this is an estimate from a photo) that a second procedure of 2500 grafts would be the maximum one could safely place, assuming an area of 60 cm2. If in fact the angles (of your newly transplanted hair) proved not to be as acute as they should have been, carefully placing the grafts in the area at a more acute angle (so as not to traumatize those hairs from the first transplant) can overcome any styling problems which you might experience.

60cm2? Isn't that a bit high, i thought 40 cm2 was about the safest density one could realisitcally pack without risking survival of grafts?

 

To my knowledge Dr.McGrath operates with a 35 cm2 philosophy.

 

Speegs-

In my post the "60 cm2" I am referring to is the amount of surface area to be covered (which is an estimate based on photos...). 2500 FU grafts over a surface area of 60 cm2 would give an average density of about 40 FU grafts/cm. And this would be an average, allowing for an additional transition zone posterior to the current transplanted area to allow for a more natural appearance should he lose further hair posterior to the frontal forelock area.

Does that clarify?

Hello Dr.,

 

A little bit yes, i'm still wrapping my mind around different professional opinions.

 

Is this assessment one you've constructed through your practice or one that is found in recommended medical literature?

Originally posted by the B spot:

Speegs, is there are reason you are unwilling to travel out of Texas?

 

Anyway, a good rule of thumb is to multiply your NW level by 1000-- so in your case a NW3 would need 3000 grafts--however, because you still retain some thinning native hair, that is where the 2000-2500 from Dr. Arocha probably comes in.

 

The other clinics are not able to do work much over 25 fu cm/2 and quite honestly, you should contact Pat personally about one of the names on your list. I am not a liberty to discuss that topic.

 

However, if you are not satisfied with your findings there, a drive to Dr. Alexander or Dr. Keene in AZ is possible.

 

Lastly, if your concerned about the disparity of graft totals, post your pics online or simply consult with other top clinics to get a better feel. I believe most will be around the same # as Dr. Arocha.

 

Take Care,

Jason

I'm willing to travel, i just was researching local first. Who is Pat?

Originally posted by Leeson:

Depending on how dense you would like, a 2,500 for the front 1/3 will give you decent density, depending on forelock. 1,500 would be somewhat thin. This of course depends on where the hairline is placed, temples, forelock density, hair count and characteristics, etc.

Still, without a pic, I'm kinda guessing blindly.

All I've got are four doctor opinions.

 

2500

1400-1600

1500-1800

1500-1600

 

Respectively, personally I think 1800-2000 would probably do it but that's just me crunching numbers after a year of looking at on-line photos and going to consultations.

 

It may well require 2500, but when three out of four doctors are proposing 1000 less than that it makes you stop and think.

Originally posted by Marko Ramius:

Gotcha. But does "doing it right" necessarily mean another 2500? Do you think another 1500 would be half-assing it? That would be 3K all in this area.

I think your assessment is accurate.

 

2500 to 3000 would be acceptable to frame a hairline and provide believable density to the frontal scalp.

 

The question you and I face, well less you since you've had a procedure, is whether or not it all should be done with one or two surgeries.

 

One camp says do it all at once, the McGrath camp argues it risks too many grafts.

 

Its difficult to discern who is right on the issue.

Originally posted by Dr. Timothy Carman:

Marko-

Those photos are great. It would appear that (and granted this is an estimate from a photo) that a second procedure of 2500 grafts would be the maximum one could safely place, assuming an area of 60 cm2. If in fact the angles (of your newly transplanted hair) proved not to be as acute as they should have been, carefully placing the grafts in the area at a more acute angle (so as not to traumatize those hairs from the first transplant) can overcome any styling problems which you might experience.

60cm2? Isn't that a bit high, i thought 40 cm2 was about the safest density one could realisitcally pack without risking survival of grafts?

 

To my knowledge Dr.McGrath operates with a 35 cm2 philosophy.

Your hairline looks realistic, he really lowered that bad boy aggressively. maybe a little too aggressively, can't tell by these pics.

 

It seems to me the 1500 would've gone further with a slightly more mature hairline, perhaps a smidge more forehead.

 

Can't really judge until i see you at 6 months and beyond.

 

I'm looking at Mcgrath, your pics would be most helpful.

No, camera is out of whack. I'm a norwood three with thinning in the frontal forelock.

I haven't forgotten Limmer, just haven't had the time to go see him.

 

It seems that everyone in Texas has a past association with MHR or is currently chained to Hair Club.

 

Obviously just because a surgeon trained with and worked for MHR doesn't disqualify them but its difficult to vet them because of the prejudice that surrounds the large companies and the mixed bag reputation they carry.

 

Both McGrath and Arocha worked for MHR and they represent two opposing camps of tackling a norwood three, one is against a megasession for the preservation of more grafts. The other thinks he can place 2500 into a place three other physicians advised against.

 

Its a real pickle to make a good decision about that, regardless of what physician is chosen.

Hello all,

 

Let us discuss Texas based surgeons as i think it is fair to say the second most populace state in the union likely contains a plurality of the hair loss sufferers in the country along with California.

 

It is surprising to me that Texas is not better versed in known talent especially since the state boasts some of the most enviable medical research and hospitals on planet earth. You'd think a state at the forefront of the fight against cancer would be easily in stride with a seemingly trivial cosmetic surgery in comparison, alas not so it appears.

 

That is not a dig at the known commodities but rather a lament at the scarcity of reliable and artistically savvy performers in this field.

 

That said let me share with you my consultations with FOUR Texas based doctors and I welcome feed back and opining from all with experience with any and feel free to add to the list:

 

I am a norwood 3 hairloss sufferer, a classic receding hairline and fading forelock density, I look like a Jude Law clone, but at 25 years of age I'd rather not look like the 35 year old actor.

 

My in-state consultations first took me to Dr. Berardo Arocha in River Oaks, Houston; he was a soft spoken man who sized me up, drew a respectable hairline, took photographs and quoted me a 2,500 graft job that would run 10K to 12K he said.

 

Next I stayed in my backyard, simply out of curiosity and of no research, it took me to Dr. Carlos Puig in Katy, Texas, just West of Houston in the suburbs.

 

His consultant was kind and forward but some of their "honesty" was actually disconcerting, as if they were low balling their own expertise and trying to lower expectations of what was achievable. They said 10% graft ungrowth was inevitable, they hinted a displeasure with megasessions and although never used names it seemed to point directly at the surgeon I consulted with prior to them. I was turned off when they disclosed they were formerly MHR based, though interestingly enough so was Dr.Arocha at one point. Ultimately they offered 1400-1600 grafts at 7k but would lower it to 5700 if I did it the following Tuesday to fill a slot. I declined.

 

Next I drove to Austin and met with an energetic and kind doctor named Dan McGrath, a hair transplant patient himself.

He was kind and to the point, he too expressed a discomfort with doing megasessions on a norwood 3 case and estimated 1500-1800 grafts at 6k price tag. My lone complaint with him was on his website, his hairline on the web looks dense and full, in person although he is far from bald his hairline can be seen through a couple of inches. Granted obviously didn't operate on himself but his hair on his website is fuller than in person. I think he too has an MHR background.

 

Finally, just yesterday i did the most unlikely thing, I called Hair Club, not for any other reason than the fact Dr. Robert McClellan, formerly of NHI in LA under Dr. Ramsann, now works there. I frustratingly sat through the sales consultation just to get to see Dr. Robert McClellan ; he came to see me after a surgery.

he was a blunt but honest fellow, sized me up, drew a similar hairline that all three previous men had and recommended 1500 grafts.

The price was way more however because of the Hair Club middle men, 5.50 per graft plus 1,200 for after surgery therapy they promised would prevent shock loss and stimulate quicker growth of transplanted hair, aprrox 9k in all for the procedure. Too much for 1500 grafts was my opinion, I could get 1000 more for another grand.

 

So in the end these were the four doctors I have consulted with to date, Puig I don't trust.

McGrath is on the fence for me, I'm confused by Arocha's 2500 recommendation when three other physicians without fail were against that, even though it would've made more money for them.

 

And Hair Club was jacking up the prices of McClellan who is good but not worth 9k for 1500 grafts.

 

Out of those four if i had to choose today I'd go with McGrath but I'm not choosing today, I'm still exploring, I am having a hard time shaking the notion all these men have a past with big chains like MHR, any thoughts?

Originally posted by Blondie:

Same but dose varies depending on use:

 

e.g. 5mg - enlarged prostates.

1mg - hair loss

 

Both dosages inhibit with practically the same efficacy.

Yes and no, upping the dose is advisable if the benefits of 1mg begin to wane. Some men take an entire 5mg every other day instead of cutting the pill.

 

Also it is worthy of note that a 5mg pill does not distribute the drug consistently through the medication and cutting inexact fourths can lead to under medicating.

 

Personally I'd cut the pills in half, better to have slightly more finasteride in your system than not enough.

Originally posted by Winston baby:

They are same, but one pill is 1mg other 5mg, dont take 5mg in one, cut it to four pieces or more, you don't want to turn female

Turn female? Finasteride keeps testosterone from becoming DHT, it remains unadulterated testosterone, nothing feminine about that, in fact many guys have a surge in libido from it.