TC17

Shadow, I suppose if this patient was 35 I would feel differently, but, the fact is that this patient wasn't 35, he was 26. To me, it was reckless and improper to plant a juvenile hairline on a 26 year old patient who is experiencing MPB. I don't care what this patient's goals were, what his family history shows, or how well he is currently responding to medication, doctors should not do what Dr. Rahal did here. A doctor has the obligation to step step in and say NO to a patient when the patient wants something that is not in their best interests. We cannot simply subscribe to the belief that patients are adults and are capable of making adult decisions and absolve doctors of all responsibility for the decision to perform an aggressive surgery. I'm all for personal responsibility, but assuming that patients suffering from MPB are capable of fully understanding the technical limitations of surgery and emotionally divested enough from the impact of MPB to make rational decisions is not a fair assumption. I'm not saying that Dr. Rahal is unethical or that he doesn't turn patients away if they want something that is bad for them, but I do not believe that anyone can reasonably argue that using 3,241 grafts to lower the hairline and close in the temples on a 26 year old patient is appropriate. As for this patient's family history, I really don't care about it because it's not conclusive about anything for this patient. We haven't yet heard about this patient's family history, but I'll go out on a limb here and say that he has nothing worse than a NW4, maybe a NW5 in his lineage. Also, I'll venture a guess and say that this patient has good donor density and scalp laxity. I say those things because I would find it even more shocking if this patient had a family history of NW6's and 7's, or average to below average characteristics. There is no disputing that Dr. Rahal is one of the most talented hair transplant doctors in the world, but that doesn't mean he is above criticism. Based upon this and other results I've seen of Dr. Rahal's, I believe he uses too many grafts, and is too aggressive in instances where caution is warranted.

That's a lot of grafts, and a pretty dramatic lowering of the hairline for such a young patient.

I just filled my newest script from a Target in Columbus, Ohio, and I paid $9 for 30 pills. At that rate, my entire year will only cost me $27!

That looks VERY nice. It's such a minor tweak, but it really makes the hair look amazing.

spex, with all due respect, I don't think the "marbles analogy" is accurate. If you remove a row of marbles from a grid of marbles, even if the remaining marbles fall in line seamlessly, somewhere within that grid will be a row completely missing. To make the grid full again, you would have to add an additional row. Like Dr. Lindsey has done before, I prefer to think of hair as trees. If you analogize hair to trees, removing a linear row of trees would be more noticeable from a birds eye view than would removing an irregular pattern of trees throughout an area of the forest. I'm certainly not saying that FUE is superior to strip, but I do think that philosophically, it can/should be used for more than small sessions and as more than simply an adjunct to strip. Understanding and recognizing the technical limitations of FUE is step one, and fortunately, because of this forum most people without a dog in this fight are rational enough to do just that. The next step is deciding whether an individual patient is better suited for strip or FUE. That inquiry requires looking into a myriad of factors and coming to a conclusion based upon the individual circumstances and preferences of the patient. Far too often we hear that strip is the way to go for those that are extensively bald, but I don't believe that's the case. Granted, you can get the most amount of grafts by combining strip with FUE, but so what! For many people, perhaps myself included, even combining strip and FUE might not yield enough grafts to make one satisfied. If I go to a NW 6 level and cannot get coverage of 35 grafts per cm2 throughout the balding area, I'd rather have 3,000 FUE grafts spread throughout my frontal 1/3rd to 1/2 of my head and buzz down to a #1 or #2. That way, I wouldn't have to worry about keeping my hair at least a #3 and creatively style what is left to maintain an illusion of density. Again, I'm not trying to turn this into FUE v. Strip, nor am I saying that one is "better" than the other. I'm just saying that I do not agree with the philosophy that (appears) prevalent on this forum regarding FUE's "place" in the scheme of hair transplantation.

I cannot believe that this man felt compelled to have a hair transplant, his hair was already amazing. Regardless, the work does look very nice.

This is a very nice result, and with so few grafts used, too. Kudos Dr. Barrera!

I realize this patient was very bald and he "only" had 3,680 grafts transplanted, but I'd still expect a much better result. In the before photos he looks like a bald man, and in the after photos he looks like a bald man with a bad comb over. At least the scar doesn't look bad.

There's no disputing the quality of this work, but this seems like a lot of grafts on a young patient. I just hope he doesn't have much in the way of future loss.

As always, the work looks amazing. Janna, was this patient's crown shaved prior to the second surgery?

H&W is a first rate organization and I think they handled this situation beautifully. The things I hope people take from this topic (1) no doctor can reasonably guarantee a result, and (2) just because the default standard of care for a hair transplant doctor is negligence does not mean that the patient need to accept that - the patient is free to bargain for whatever terms he wishes, and the doctor is free to accept or reject those terms.

Dr. Feller is right in articulating the legal standard for negligence, but it misses the all important point of defining what the standard is. I'm not sure that the standards employed by, and the quality of work done by the physicians of this community is the benchmark. In fact, unfortunately, I believe it is far lower. For example, if a physician doesn't use microscopic dissection, only has one tech instead of a team, puts too much donor in the front or in the crown, transplants an unnatural looking hairline, or, doesn't use follicular units at all, is that doctor guilty of breaching the standard of care? Maybe, maybe not, but my gut tells me NO, that doctor has not breached the standard of care for a hair transplant doctor because the standard of care is simply to do what is reasonable, and what is reasonable for a hair transplant doctor will not be defined by the cream of the crop, i.e. the doctors of this site. I think the standard is that of the thousands of physicians NOT recommended on this site who do work that we would consider subpar. However, just because the floor is negligence, doesn't mean that patients have to, or even should accept that. Patients are free to bargain for whatever terms they want! If you're not happy with the doctors proposal, tell him to take a hike and make him a counter offer. If he is unwilling to abide by those terms, then take your business elsewhere! There is nothing wrong in contracting for a percentage of graft growth, and a refund for those that do not grow, or any other creative (legal) terms that you can work out with your physician.

Very nice job!

Is there simply no way of ascertaining whether a person's physiology will be suitable for surgery prior to the patient investing thousands of dollars, months/years of his time, physical discomfort, and emotional investment? Regardless, if a patient's physiology does not lend itself to a successful surgery, who should bear the financial burden of the failed procedure?

aaron1234, how many pills are you getting for $9? I last filled my prescription in February of 2010 and I believe I paid roughly $200 for 90 pills of generic proscar at Walmart. I have to get my new script filled this week and I was just wondering if the price dropped. On a related note, does anyone know how long proscar keeps?

Amazing.

GREAT result! And if your scar is anything like most of those done by Dr. Rahal, I'm sure it's almost unnoticeable.

hdude46, I know what you're talking about, but I don't think that H&W have any more dissatisfied patients than other doctors. Because H&W are two different doctors, it's fair to say that they're performing roughly twice as many surgeries as those clinics that employ only one physician. That doubles the chance that a bad result will happen. Further, H&W seem to be the most popular clinic on this forum, so we see more results posted by patients of them than we do from patients of Rahal, True & Dorin, Konior, SMG, Cooley, etc. I think the question we should be asking ourselves is what percentage of all hair transplant patients achieve poor results? Unfortunately, it appears as though that percentage is higher than many of us would like to admit, even if you go to one of the top physicians. And, if you're one of the unlucky ones who gets a bad result, well the fact that your doctor has a great reputation is of little consolation to you, and I think unfortunately, many members of this community will attack you if you post your negative experience, and blame you for having "too high of expectations." *I think, if you want to discuss the pros/cons of dense packing and megasessions, you should start a new thread, but it's an interesting topic that has produced very different views from doctors and patients.

To my eyes the area covered looks much smaller than 200cm, and because this man had a decent amount of hair in the recipient area prior to this surgery, I would have expected a better result for 2,700 grafts.

Before this topic devolves into something worse, I just want to add my two cents. Far too often on this forum instances like this occur. A poor result is posted, and make no mistake about it, this result is absolutely awful, and clinic cheerleaders jump in to defend the clinic, while clinic bashers jump in to bash the clinic or doctor. The result is that the topic goes off course, gets locked, and nothing is resolved. That's not helpful for anyone. The issue of H&W and the height/length of their strips isn't relevant to this result at all, so I have no idea why it was brought up. It does nothing but detract from the issues NotHappy, which were poor growth and poor customer service. Lorenzo, whether carefree has an agenda is also irrelevant. He had a concern about an incident and brought it up publicly. Even if he did so with malicious intent, highlighting an actual concern of an actual patient is not a bad thing. I think you jump in and defend H&W far too often, and I believe that tends to rub some posters the wrong way. H&W have an OUTSTANDING and well deserved reputation on this forum for great results and great responses to dissatisfied patients. However, they, just like all clinics, are not above criticism. Try to keep that in mind. There is no need to defend them in every instance. We all know that Joe is going to come on here and handle this in a way that is satisfactory. Let us all just pump the brakes and wait until more information is brought to light before rushing to judgment one way or the other.

Just another amazing example from H&W. Joe, do you have any immediate post op pics?

orangehair, Thanks for responding to my concerns, I appreciate it. Is this man suffering from DUPA, or does he simply have very low donor density? Out of curiosity, do you know what his average donor density was prior to surgery? Last, approximately how many more grafts can be taken from his scalp without it appearing moth eaten? corvettester, Although we all know that hair diameter, skin to hair contrast, and a host of other factors influence how good a certain amount of grafts looks, I believe that some doctors are just plain better at producing cosmetically pleasing results with fewer grafts. True & Dorin are in that group of doctors who I believe get great results with a seemingly low number of grafts.

The hairline looks amazing, and I'm sure it will thicken up some more in the coming months. However, and this is just nitpicking here, his donor does appear to be noticeably thinner in the after photos. That is surprising to me considering he only had 1500 grafts extracted.

A great result, but I question the wisdom in transplanting the crown on such a young patient.

Really nice. Dr. Haber has been presenting some very good examples on this forum lately.