TC17

I think you should also consult with a doctor about a possible scar excision. Dr. Lindsey has posted numerous examples of scar excisions on this site. In addition, he has convinced me that scar excision is superior to placing FUE grafts into the scar. Because you have so many scars it might not be possible, but don't limit your options. If you're dead set on FUE, and you're trying to decide between the above three you mentioned, I would say go with Feller.

Thin, but nonetheless a great result. If the hallmark of a great transplant is undetectability, then this is certainly great. This patient has very aggressive balding for someone under 30, and to me that would seem to signal that in all likelihood, he will become a NW 7. Dr. Panine, in your opinion is the 3,200 grafts the most that you felt comfortable in transplanting because of his degree of balding? Also, in the likely event that this patient continues to lose more native hair, what is the plan? Last, do you have any immediate post op pics? I would like to see where the grafts were placed. All in all, when you consider the small number of grafts used, I would say that this is a very good result.

I don't understand how this nonsense that Dr. Hasson is for hairlines and Dr. Wong is for crowns started. I think that saying unfairly diminishes the work of Dr. Wong. In my opinion, Dr. Wong's hairlines, and his work in general, is second to none. This appears to be another typical result for Dr. Wong. Congrats on another job well done.

Considering the number of grafts that were used, and the surface area that was covered, I would say that this is as good of a result as someone could hope for. The hairline is very natural, and in my opinion the guy looks much better. I gotta give kudos to Dr. Meja for a job well done, and for posting a top down shot. *on a side note, how many grafts would you say that this patient has left if needed? his donor appears very thick, and with that wave in his hair, he would seem to be the type of patient who could have a "full" head of hair if he wanted.

I echo what Bill and thana said. It is an extremely subtle, yet a much improved, hairline. Anytime you can get a nice result using so few grafts I am impressed. I don't know what Dr. Kabaker charges, but there is no way that this surgery cost more than $4,500 - 5,000.

I agree with PGP. I prefer the work of Dr. Wong's work to that of Dr. Hasson, including hairlines.

I really want to know who this doctor is too. In fact, I don't think it's fair to the doctors on this site who did not perform your surgery that you haven't yet named your doctor. By describing your physician as "very reputable", and "well known in this forum", many people will simply let their imagination run wild with possibilities. Just my two cents.

Also, please read this response to a similar question that Dr. Paul Shapiro answered. His third point addresses the possibility of donor thinning.

No, the hairs have not "died out", it's just that you cannot access all of the available grafts in the area with strip or FUE. Strip surgery involves cutting a long (24 to 30cm), relatively narrow (1 to 2cm) strip from the back of the head, and then microscopically dissecting the individual grafts from the strip. The skin is then pulled together and sutured, usually leaving a thin scar that is well hidden by existing hair. Essentially all you are doing is taking a strip of hair and transplanting it to other parts of the head. The average patient has around 80 follicular units per square centimeter. So, assume that you take a strip that is 28cm x 1.6cm, you will get a total area of 44.8cm. If you have the average 80 fu's per sq/cm, that will give you around 3,600 grafts. After the skin heals, you can take another strip, but you will probably not get as many grafts because the skin has tightened somewhat. All in all, the average person has around 6,000 grafts available for transplantation using strip methods. However, in some patients, the donor area does thin. Say your donor area thins to around 65 fu's per sq/cm, and you take the same size strip, you would get get around 2,900 grafts. The safe zone is usually impervious to balding, but there are men who have minor, moderate, and even severe thinning in that area. The thing that I have found very useful is to look at the hair of men who are 60+. In a sizable number of those older bald men, a strip scar would be visible. I just keep thinking to myself what would have happened if that 65 year old man had undergone a transplant when he was my age? (26) I personally think that FUE is the better approach for younger patients with uncertain balding patterns because the linear scar is a non issue. I started a topic a few weeks ago that considered the pros and cons of both FUE and strip surgery for the younger patient. I think it might prove helpful for you. You will hear it a million times on this forum, but really let it sink in - RESEARCH. You can never know too much about this field, after all, we are talking about your appearance for the rest of your life. http://hair-restoration-info.c...=702109833#702109833

Ron J, Either you did not properly understand the analogy, or I did not do a good job of conveying what I meant. Either way, here is the explanation. If an infinite supply of grafts existed, the major impediment for a successful surgery would disappear. EVERY coalition doctor can produce 100% natural, top notch results, if they are given unlimited resources. (focus on the term resources, and don't let the fact that the resources I speak of happen to be a # of grafts, throw you off) Likewise, if you give a top chef like Joel Robuchon any ingredient he wants, he will cook you a meal that is out of this world. But, if you tie Chef Robuchon's hands by saying that his dish can only have X amount of saturated fat, or that he cannot use black truffles, or that his meal must come in under $75 per person, the true skill of the chef comes out. Granted, arbitrarily limiting access to a chef is different from the limitation placed upon every surgeon, but watch Master Chef on TV and you will see that the chefs are given random challenges to test their skill. It doesn't matter if the limiting factor is a quantity or a quality, all that matters is that a limiting factor exists. If you believe that every doctor produces the same results with the same number of grafts, then so be it. If that is your starting point, then anything I say will never be in agreement with your beliefs. If that's the case, that's OK, but I do not share that same belief. I believe that some doctors accomplish more with less. I believe that some doctors place grafts in such a way as to maximize their cosmetic value. You asked if I believe if some doctors on this site are unethical? I would say sure, why not? I have no idea if Dr. X cheats on his wife, steals, doesn't report his taxes, etc., but I don't care about those things. Ethics and risk are two different things. I don't care if a doctor is ethical in his personal life, provided he is proficient in his professional life. I do not believe that any doctor on this site would KNOWINGLY do anything to harm a patient. However, I do worry when I see doctors touching the crown on 22 year olds, or taking a scar so long and high that future loss can expose it. For what it's worth, I don't believe that Dr. Armani perceives what he is doing as risky though either, but most of us agree that it is. Analogy number two, and hopefully this will quell any questions into my personal beliefs. If your plane crashes in the middle of the desert, and you only have 1 gallon of water, how do you ration the water? Are you going to chug the first 1/2 gallon within the first hour, are you going to use it wash your hands, are you going to drink 1/16th per day? You may be rescued within 10 minutes, you may find a stream on day two, or you may be stuck in the desert for a week with no water other than what is in your canteen. The point is that you do not know how long you will be in the desert, just as you do not know how bald you will go. If you're the type of person who decides to drink a lot in the beginning in the hopes that you'll be rescued or find water, cool. But, I'm not that person. I'll figure out exactly how much water I need per day to survive, and ration accordingly. Maybe by day 4 I'm rescued, and my canteen still has 1/2 a gallon left. In that case, I may look back and say "damn, all those times that I was thirsty I could have had more". But because I didn't, and COULDN'T know when I would be rescued, I did the smart thing and kept enough to survive a little while longer. The "average" patient only has 6,000 grafts available for transplantation. I would venture a guess and say that the average NW 6 and 7 has FAR less available, as evidenced by the graft counts of the NW 7's on this site. Assuming that JS possesses the average of 6,000, the 2,700 recommended by Dr. Alexander is 45% of his total number of grafts. To me, that's a relatively large percentage, even if it is admittedly, a seemingly small number of grafts. Just remember, family history, meds, current loss, and any other barometer of future loss are merely guides. Someone in your family is already, or will be someday, the baldest in your family. Who knows, it could be you.

I really like Dr. Rahal's work, but I think that Dr. Feller's approach is the better one. I see no reason why you won't be completely satisfied with your surgery on the 5th. Congrats on picking a great doctor!

It does look very good Abby! Dr. Mohmand has put out some very impressive results.

DeVroye, Shapiros, Feriduni, Bisanga, Konior, Gabel, and maybe Dr. Umar and Dr. Wolf.

I used to think it was a HT, but now I'm not so sure. There are a number of photos of him surfing, running, etc., and it doesn't seem like a rug, but his hair is SO thick that I struggle believing it's a HT. Another thing is that if it was a HT, he had to use an awful lot of grafts to get that type of hair back. Just because he's a movie star doesn't mean that he's not going to continue to bald, so if he used up 40 or 50% of his donor just for the hairline, what will happen in the future?

I agree, but also disagree with you hair_care. Dr. Bernstein certainly has a reputation for being conservative, but I'm not troubled by that at all. The fact is that hair loss is uncertain. Because we are undertaking a significant risk with our future appearance, the prudent man should should be overly cautious when planning a procedure. Unfortunately, when you have doctors who are by comparison far more aggressive, Dr. Bernstein's approach is difficult to get behind. With that being said, I completely agree that for a doctor to be mentioned as great, he MUST be able to transplant more than 2,500 grafts in a single session when appropriate. It does seem very strange that even in older, less risky patients, Dr. Bernstein seems to stick to the lower graft numbers. He may have a very good reason for doing so, and in 10 or 15 years, his conservative approach may be shown to have been the correct approach. Only time will tell I suppose. I did read on his site that the reason he has not undergone a transplant is because he is not a good candidate because of his level of balding and his thin donor. I would guess that that has something to do with his conservative approach. I am sure that at age 25, 35, 40, etc., his donor would have been able to support a number of grafts for transplant. Yet, at age whatever, he is no longer a candidate. What then would have happened if he had undergone the transplant at a younger age? Just because someone does not show miniaturization in the donor at the present does not mean that it will not occur in the future. Again, only time will tell if people are making a mistake by going under the knife in the face of such uncertainty. *also, other than what I feel is extreme cost, the other issue with Dr. Bernstein is that he very rarely posts top down and back of the head examples of his work. without those, it is extremely difficult to accurately gauge his work.

I also like Dr. Bernstein's work a lot. However, he charges $6 per graft for strip, and $12 per graft for FUE! Even though I really like what I have seen of his work, I would not even consider visiting him because of his high price. If cost is truly not a factor for you, I would visit Dr. Bernstein. Of your list, he is my personal favorite.

$6 per graft for FUE is very reasonable. I know there was some controversy regarding Dr. Umar on this site a while back, but I like the work that I have seen of his. It seems that $6 is about the average now for FUE. The Shapiros, Wolf, Feriduni, Bisanga, and DeVroye are all around that number, or even slightly lower. With newer tools and more top notch doctors offering less expensive FUE, I expect the procedure to continue to drop in price and be more accessible to a larger number of people.

Oh, and thana, I am not saying go for low graft numbers. I am merely saying that I believe our perception as to how many grafts are required is somewhat skewed. Because Dr. Paul wrote the article I will use him as my example. Dr. Paul produces excellent results. Dr. Paul uses the graft numbers that he believes to be necessary to produce those great results. Therefore, the next step is that Dr. Paul's graft numbers will be sufficient to give us excellent results.

It is difficult to compare any patient with another because of the differences between any two people. Obviously, you cannot make a genuine apples to apples comparison. With that being said though, it seems to me as though there are a few physicians on here who achieve consistently great results, yet use less grafts than some of the other physicians. The analogy I think of in my head is that to a group of great chefs. Every chef, if allowed to use heavy amounts of salt, fats, creams, and other unhealthy ingredients (large # of grafts), can create a gourmet meal that is a pleasure to eat. But eating such an unhealthy diet can lead to a myriad of health problems down the road, so it should be avoided (possibility of running out of donor and looking silly). It's not a challenge to the chef to use the unhealthy ingredients to create the gourmet meal, and frankly you will leave the restaurant happy as a clam after eating it. But what about when you're older and you're suffering from the health problems? Will you still feel that the unhealthy eating habits were worth it merely because it tasted good in the moment? On the other hand, if you tell the chefs that they must keep the meal healthy, the true skill of the chef will come out. With these limitations in place, can the chef still cook a meal that knocks your socks off? My opinion is that a number of chefs (doctors) can, and I will go on step further and say that their healthy meals taste just as good as the unhealthy meals of some other doctors. The discomfort of a possible second surgery will pale in comparison to the lifetime of looking freakish if too much is done too soon. Until baldness can be accurately predicted, count me as firmly in the corner of those doctors that do not touch a crown on a younger patient, do not use more grafts than are absolutely NECESSARY, and do not cater to the whims of the immature patient. I've attached some links of some work that I feel is absurdly good by some of the doctors that seem to be more "conservative", as well as that article written by Dr. Paul Shapiro on their basic guideline for graft numbers. I believe my main point stands without contention though. Find a doctor whose work it is that you like, and say to hell with graft number. If you like the work, you like the work. (unless of course the doctor recommends too many grafts, at which point you'll be screwed in the future) http://hair-restoration-info.c...=615103223#615103223 http://hair-restoration-info.c...=158100281#158100281 http://www.hairtransplantnetwo...tientID=1879&DrID=16 http://www.hairtransplantnetwo...tientID=1621&DrID=16 http://www.hairtransplantnetwo...tientID=1437&DrID=16 http://www.hairtransplantnetwo...tientID=1648&DrID=18 http://www.hairtransplantnetwo...tientID=1707&DrID=18 http://www.hairtransplantnetwo...ientID=1579&DrID=263 http://65.36.174.14/Consult-a-...tientID=1864&DrID=54 http://65.36.174.14/Consult-a-...tientID=1718&DrID=54

I don't think I've ever seen a 21 year old with such extensive hair loss, you look to be at least a NW 6.5 and unquestionably moving towards a NW 7. Realistically, there is a strong chance that you are not a candidate for a transplant because of your loss. If anyone is going to turn into the 50+ year old man with a see through donor, it would most likely be someone with your pattern. My opinion is that your best bet is to forget about a surgery. Even if you are a candidate for a transplant, do you really want to be 21 with a pattern that only looks acceptable on men who are in their 50's? There is no doubt that Dr. Beehner has made improvements to a number of NW 7's on this site, but the look is only appropriate because the men are all 30 years older than you. In my opinion, men our age are far better off buzzing or shaving down, rather than having a thin, high hairline, with nothing behind it. Ultimately it is your scalp and your decision, but just be careful.

It looks great dude.

There are other doctors out there who perform high quality FUE other than the two you mentioned. However, if you're deciding between those two, Dr. Feller should be your choice in a landslide. Nobody here knows much about the Australian doctor because he shrouds his work in mystery. Compare that to Dr. Feller who has dozens of PATIENT posted examples of his work, detailed posts about his FUE tools, and an overall transparency that is second to none. I would never risk visiting a doctor who is so reluctant to open his techniques and results for the world to see. Again, if you're only consider those two, do yourself a favor and visit Feller.

I agree with hairloser1. The number of grafts is merely one of many factors that influence the success or failure of a transplant. I believe that you shouldn't concern yourself too much with the number of grafts Dr. Alexander has recommended if you are comfortable with his results. If Dr. Alexander believes that he can achieve your goals with only 2,700 grafts, then great. Just because some doctors may recommended 3,000, 3,500, 4,000 or even more does not mean that you cannot achieve the same results with less grafts. My point is that the important thing for you is to look at the results of the physician, and not get caught up in graft count. If you like the results of Dr. Alexander more than any other doctor, you should visit him and trust that he will do right by you. Putting your faith in a doctor who you have thoroughly researched and subsequently trust to give great results is not the same as blindly trusting any quack doctor who practices hair restoration. If I love the results of both Dr. A and Dr. B, but Dr. A recommends 2,500 grafts and Dr. B recommends 3,500 grafts, I personally would choose Dr. A every single time. Results are what matter, not graft count.

That doesn't make sense. Generic dutasteride and brand name dutasteride are identical. Unless what he purchased online isn't actually dutasteride...

Dr. Kulachi is by far the most physically attractive surgeon recommended on this site.