TC17

As usual, another amazing result from Dr. Konior.

"Keep in mind that every class 7 patient had his day in the sun when no one on the planet could have found any trace of miniaturization in the area that would eventually convert into a virtual sea of baldness." That quote should be read by every prospective patient before undergoing surgery.

orlhair1, you are correct in putting the emphasis is on the word "potentially." You may never have a noticeable change in the donor area, you may have a quite significant change in the donor area. The point is not to scare people away from surgery, it's simply to recognize that this is a possibility that should be discussed more often than it is, and that proper long term planning is not a luxury, it's a necessity.

Donor thinning is NOT rare. I've been screaming that from the mountain top for years on this forum, and yet few people have acknowledged it as a reality. I'm glad that this issue is finally gaining some traction and being discussed. I do my fair share of people watching and it's my opinion that roughly 40% of the men I see who are balding in a NW5+ pattern and who are over the age of 60, have a thinning donor area. One is certainly free to call BS on my estimate of 40%, and that's fine. But donor thinning does occur, and according to Dr. Konior, he sees it "quite frequently." (for the record, my dad just recently started to thin in his donor region on the sides of his head. he's about 60, and this just started within the past 2-3 years, so I'm acutely aware of this possibility) Assuming we all agree that donor site thinning is not that rare, and really, I don't think that's even a question anymore, ask yourself then how is it that a doctor can accurately ascertain the number of grafts that a patient has available to transplant? Scalp laxity and hair density are certainly ways to do so, but that assumes that the number of grafts remains constant throughout the patient's life. I beileve that's a faulty assumption. But, if we assume that the total number of grafts remains, and it's simply the hair that shrinks in the donor area, well then the graft estimate may be accurate, but who the hell cares? 1,000 grafts of strong, solid, thick diameter hair is better than a 10,000 grafts containing wispy, thin, cosmetically insignificant hair. My point is that it's of no consequence whether the hair simply thins while the graft count remains the same, or if it is the graft count being diminished in the donor area. It doesn't matter because the effect is the same - the patient's transplanted hair will thin, and his donor may show a scar.

I agree completely with what has already been said.

The most recent photos that you posted with your hair dry look MUCH better. Is there a reason why you're not taking Propecia? With your relatively young age, aggressive hair loss, and the fact that you've already undergone surgery (thus removing the option to buzz your head), it would seem as though Propecia would be a necessity. The other good news is that while you might not have had great results, you've "only" used 4,000 grafts. Assuming you have average laxity and density, you should easily have another 2,000-4,000 grafts from strip alone left. What did Dr. Feller say regarding your donor?

I hope this works out well for you, but I just do not think it was prudent to transplant the crown on a man who was only 28, and then to go back a few years later and add MORE grafts to that area, wow. You look like you are thinning in the front where no grafts were placed, and yet you already spent 5,400 grafts in a 75cm2 area? I realize I'm going to catch some flak for this post and I'll be accused of bashing Dr. Rahal, but I just don't think this was appropriate planning.

Dr. Paul, Thanks for taking the time to respond. I still have some follow up questions that I hope you can answer. Assuming it is simply the hair "thinning" and not falling out, wouldn't removing additional donor hair increase the risk of the strip scar showing on these types of patients? It seems like in effect one would be robbing Peter to pay Paul, and perhaps look worse in the long run. And second, again assuming it is the hair simply thinning and not falling out due to an illness or other problem, generally speaking, if a doctor examines the donor area thoroughly, is he capable of foreseeing the donor area thinning in the future, and if so, how many years out? I realize all patients are different, but as generality, upon microscopic examination, can a doctor say with confidence that a patient's donor area is secure for 3 years, 5 years, 10 years, 15 years? Or, is that prediction not possible for any period of time, and we should view that possibility as simply another risk of surgery? Thanks again Dr. Paul, and I look forward to your answers!

These questions are for any doctor who wishes to answer. 1. Assuming that it was transplanted hair that was lost, wouldn't a "fill in" procedure simply be a temporary fix? It would seem as though if the donor hair is destined to fall out, the only thing planting more of it would accomplish is delay the inevitable, while costing the patient time, money, and pain. 2. Once again, assuming it was trasnplanted hair that was lost, wouldn't there have been evidence of that inevitability upon examination of the donor area prior to surgery? I realize predicting the future is impossible, but this patient is saying it has only been three years since the surgery. I was under the impression that you can foresee changes in the hair upon microscopic analysis at least a few years in advance.

usedandabused, I know you had a bad experience with Dr. Epstein and I know that your results sucked. I truly sympathize with you, but why would you revive a thread that was almost two years old?

Magneto, you are free to have your surgery performed by whomever you wish, and everyone here will wish you nothing but the best. If you feel comfortable in Dr. Keser then by all means go to him! That being said, your rant is absurd. The fact of the matter is that there were valid concerns about Dr. Keser's approach to hair transplantation that included, but were not limited to donor management in young patients and low hairlines with closed in temples. Dr. Keser was given numerous opportunities to address those concerns here on this forum, yet he chose not to. Why should this forum allow Dr. Keser to reap the benefits of it, if he refuses to answer basic questions about his practice? Nobody here has anything against Dr. Keser, in fact, most people here found his work to be quite good and were excited about the possibility of him joining this community. But we must remember that chnical proficiency is only one part of the hair transplantation process, and although Dr. Keser seems to be an excellent physician technically, he seems to fall short when it comes to the other facets that make a truly great physician. Dr. Keser was given the chance time and time again to remove those concerns, instead he chose to run away from them. Take from that what you wish. Finally, as to your "freedom of speech" reference, you should be aware that the First Amedment only applies to state actors. This is a private forum, and thus the moderators are free to restrict or remove any post they want to. The fact that they do not, the fact that this forum allows us to pose hard questions to physicians, to review work, to get support from other members is a privilege, not a right, and one that we should be thankful for. I too wish that Dr. Keser's results would have remained, but I wish more that Dr. Keser had the stones to answer the questions about his practice. Instead of attacking Bill andDavid, why don't you read some of their previous posts and see how they have helped innumerable people.

To me, it looks as though this woman has had growth.

Dr. Lindsey, the donor area looks great, and the recipient area looks nice and clean. I hope this patient keeps you updated, and you in turn keep us updated. Out of curiosity, how old is this patient and what did his preoperation examination show regarding his balding pattern? Based upon photograph #3, he appears to have some retrograde alopecia and perhaps even some thinning in the donor area. Also, it looks as though he might thin in a NW7 pattern. Thoughts?

Good luck! It is clear that all of your research has paid off, because you are going to one of the very best surgeons. I look forward to tracking your progress.

The examples posted look very nice, certainly worthy of recommendation. As for Dr. Wesley's conservative approach, well, I'm sure most know that I tend to lean on the cautious side when it comes to hair transplantation, so I view that as a plus. However, because I know nothing about him or his work I cannot offer an opinion. But, if the physicians already recommended here are familar with him believe that he is worthy of recommendation, then that is sufficient for me.

Simply beautiful.

Your result is beautiful. Dr. Rahal, as he almost always does, did a great job with you.

It's clear that egghead had an ulterior motive for starting this topic, but that fact doesn't mean that the point raised isn't valid. I'm not going to spend my time digging through old patient logs, but I can say that I too have seen many examples of strips taken very high. And whle Dr. Hasson has taken the time to explain why he does so on other forums, I just just don't buy the explanation. The sides on many men drop far below where some of those strips have been taken. Granted, it doen't matter what anyone else's hair does, only your own, and if your hair doesn't drop on the sides, then you're safe. However, Dr. Hasson cannot know what a patient at age 35 will look like at age 55 with regards to the height of the hair on the side of his head. And as for retrograde alopecia forcing the strip to be taken higher, perhaps instead of taking a higher strip, that should be viewed as a sign that a hair transplant shouldn't be done on that particular patient in the first place. Just because H&W do something, or say something, or hold a particular philosophy, does not mean that it is right. This myth of infallibility needs to go away and go away soon. I hope that we are all mature enough to engage in a discussion about this topic without resorting to name calling, posturing, or cheerleading. Egghead's goal was to see this turn into an online fracas. Do not let him accomplish that goal. We can disagree with one another and remain civil and respectful.

I agree with RC that Dr. Panine has been posting amazing results, and he might just be the most underrated physician on this forum. It will be interesting to follow your results as I do not recall seeing any patient posted results of Dr. Panine.

You're showing improvement. It also appears that you are beginning to have some very fine hairs growing in the recipient area, too. Hopefully in the next 6-8 months those will mature and you will be satisfied with your result. If not, don't panic, you know H&W will take care of you.

Shadow, what you said was ridiculous. There are many patients, even some NW 7's, who have beyond a "cosmetically acceptable" result. I'm not promoting H&W here, but take a gander at their website (you know, the one with the HD photographs and videos of NW 6's and 7's) and then tell me those results aren't amazing. What bonkerstonker said is absolutely accurate. The truly great doctors on this site are fully capable of creating low, dense hairlines, complete with closed temples. They just do so less frequently because of reasonable concerns about the future and how that hairline will look on an older man who continues to lose hair and has a depleted donor supply. Nobody can predict the future. The only things we know are that hair loss is unpredictable and that grafts are finite. Those factors implore us to be cautious when undergoing a surgery and to use our limited grafts judiciously.

I agree with what everyone else has said, you have definitely had some growth, and it's definitely way too early to worry! You're showing growth, and if your result is less than optimal, we all know that H&W will take care of you.

Each has a good reputation for a reason, so I'd advise you to go with whomever you feel most comfortable with and whose work you prefer. Although it is often said that travel shouldn't be a factor in your decision, for me, if there were two doctors who I thought were equal in skill, but one was closer/cheaper, I'd go with the closer/cheaper option.

I'd go with Bisanga only because I've seen more work of his.

I just don't see you as a hair transplant candidate. To me, you're just too young with too aggressive of hair loss to be a suitable candidate.