mayhem

27 minutes ago, Gasthoerer said:

In general I agree, that conservative is the best way to go forward (just see my own case as a reference :-)) 

But I think you are over critical here and you are using a very aggressive language ("very weak", "not ethical"): 

If someone is a low NW (like this patient) with a strong Donor, no signs of further thinning at the age of 28 (which is not really young) and a positive family history, then how high is the risk that he will end up a NW5+ and run out of grafts? I think it is very low, especially if you accept a thinner crown when being over 50. 

That said: I myself would have not gone that aggressive in one step, but I understand that not everyone is like me 😉

I really don't know how else to describe Dr. K's reply, because it seemed like a dictionary definition of what we all more or less understand regarding family history, donor strength, current age, current regime, etc. 

It did not seem to me to address this particular case. 

Instead, Dr. K referred to past patients (not specifically) who did not progress further in their hair loss. I questioned whether that has any bearing on this case (or to each other). 

But of course, if this patient is meant to stay at a NW3 with either zero or minimal further loss then he's really fortunate and I'm worrying for nothing. 

I just don't see how anyone can know that for certain. 

Mind you, I'm not saying this patient should never get a hair transplant. 

I'm just saying why go so low right away. Again, from the doctor's perspective. I'm sure the patient wanted this. I would too if I knew I wasn't going to lose more hair. 

5 minutes ago, 1978matt said:

The patient here doesn't have an advanced pattern.  I'd say he was a NW3 and the doc would have looked at the remaining hair on the top of his head to see if it was exhibiting signs of thinning.

Evidently, whatever he saw was not significant enough to rule out the agrressive approach taken.  Also, the 18-month post op photos do not appear to show any noticeable deterioration behind the transplants.

Matt, what exactly do you think a doctor can SEE during a consult?

Sure he could check for miniaturization but that doesn't preclude future hair loss. 

If he is indeed going to be stuck as a NW3, then this is awesome.

I just don't see how Dr. Konior (or anyone else) can predict that. 

It's irresponsible to suggest that he can. 

1 hour ago, JayLDD said:

I'm not going to babysit you with statistics when what I said was totally uncontroversial. Most men go for hair transplants prior to being completely bald. Your subsequent sentence has absolutely nothing to do with anything being discussed in terms of relevancy. 

I was being facetious.

You have absolutely no data to back up your claim. You've conducted no survey.

You have an 'impression' that does not even rise to the level of anecdote. 

Even if you did, the sample size is this forum. Hair loss affects most men to some degree, not just those who talk about it on THIS particular forum. 

Didn't think I needed to state the obvious.

1 hour ago, JayLDD said:

[...] this patient is likely to have still 4-5000 FUE grafts left and the option of FUT and BHT beyond that. That is quite frankly highly likely to be enough to get full coverage across his entire head as a NW5 if he exhausts all surgical options. Even if it was the case that he could not cover the entire top of his scalp, he will absolutely be able to cover the vast majority of it even if he ends at a higher NW.

You're erring on the side of optimism. IMHO, I think all doctors should be cautious. Especially when it comes to a finite resource like hair. 

1 hour ago, JayLDD said:

Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. 

I'm voicing my opinion on this case.

Just because someone disagrees with you does not make them a fear monger.

1 hour ago, JayLDD said:

 

You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. 

[...]You're right time IS the issue, and this patient has bought substantially more of it in the years it matters most. Even if he progressively loses significantly more hair he will be in a good position going forward and the worst case situation is a bald crown and a strong frontal third. Do you think the patient is going to cry about that when they're 45 years old? No, they're not.

Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants.

I'm sure there are doctors out there who will provide the patient with whatever they desire even if it's not in their interests.

While Dr. Konior is one of the best HT surgeons around, I do not think this case was ethical. Dr. Konior's rationale was very weak too.  

I'm looking at this from the perspective of the doctor, who should be operating ethically. 

6 minutes ago, JayLDD said:

Do you think that when someone hits 30 that their hairloss magically stops, becomes completely predictable and controllable?

Hair loss is unpredictable. 

However if someone has advanced hair loss when they're young, then it's not a good sign. We can't predict when they will go bald or whether they will go bald at all. 

But no one would look at this patient pre-op and bet confidently they'd have no further loss until 40. 

6 minutes ago, JayLDD said:

Your argument makes no sense. 90% of patients on this forum have progressive hairloss and aren't completely bald yet. You could say the same to them, age has absolutely nothing to do with it.

Can you support this statistic with some evidence please? Can you say whether this statistic, if valid, generalizes to the rest of the male population outside the forum?

Age isn't the issue in and of itself. TIME is the issue.

If you have an advanced pattern at a young age, then you have much more TIME to keep potentially losing more hair as you get older and older. 

42 minutes ago, Curious25 said:

Have you not read Dr K’s comments earlier in this thread, providing his justification? 
 

 

Yes I did. 

Dr. Konior's response seems bizarre. He acknowledges that an ethical doctor would consider the patient's family history, current hair loss, age, regime, etc. 

Yet, if one were to do all those things - how could he justify giving this patient a juvenile hairline?

Hair loss can strike at any age and it is unpredictable. Dr. Konior cannot predict this young man's hair loss.

As others have said, you can always lower the hairline - but if you start off by giving a patient a NW1 or juvenile, then you take away any consideration for further loss. 

I wonder how much donor this person has left. 

On 4/13/2018 at 11:18 PM, matt3480 said:

 

Gee, thanks for your opinion, Doctor (er, I mean poster who hasn’t even had a HT). :rolleyes:

Matt, no doctor can PREDICT a person's future hair loss. 

You're implying that we all must ignore our common sense here.

Dr. Konior gave him a juvenile hairline when he clearly is going to lose more hair down the line.

He brought the guy's hairline down an inch. 

On 2/17/2018 at 2:22 PM, Dr. Raymond Konior said:

With respect to the comments of Mr. Hassler, I question his rational in believing that every man with an early pattern will progress to an advanced pattern as I have many long term patients over a 30 year career who have never progressed beyond a lower graft classification.

The patient was 28 when he had the surgery, correct? Everyone is different, but is his advanced horseshoe pattern not a red flag? 

Put it this way, if this patient were your son and they had the same NW3+ advanced hairline - would you have given them a juvenile hairline as a 28 year old?