Pat - Community Publisher

Bruce, Thanks for your helpful response. I agree except that FUE, does create a scar. But since the round punches used to punch out the follicles are typically less than 1mm the scars then to be so small that they are typically not visible unless viewed under very close inspection. In addition as the small round wound heals it typically contracts thus reducing the scaring area to less than 1mm. One other advantage of FUE is that healing and recovery time is typically faster than strip surgery. However, another disadvantage of FUE is that the donor area typically needs to be shaved down. For patients who typically wear their hair longer this can be an issue. To view a comparison of FUE and strip surgery, including video of FUE being performed, click here . Cottonnc, best wishes for selecting the procedure that is optimal for you. Pat

I appreciate everyone's impassioned input. M & M and Wylie, thanks for stepping in and interjecting some good points without jumping into the ring like an angry relative on the Jerry Springer Show. I believe today's dramatic episode is wrapping up (It's now around 11pm on a Saturday night) and it's time for me to do my "Hairy Springer" impersonation. Here goes: Folks, we're all here to get hair not pull each others out. I think when the facts and issues are divorced from the personal attacks I see many genuine and passionate concerns. I feel that strip and FUE both have a place as legitimate hair transplant options. Modern strip surgery is a proven cost effective method for restoring hair in the balding areas. It will leave a long and hopefully pencil thin scar that will be of no cosmestic concern to the patient. I know that has been true for me and hundreds of thousands of others. Of course, many over the years have been left with scars in the back of the head that were as wide as 2 cm or even wider. Such scars are then a cosmetic issue. In even rarer cases the patient may have even experienced nerve damage. Fear of such scarring largely fueled the development and interest in FUE. Fortunately, when performed by truly qualified physicians using optimal donor and closure techniques, cosmetically significant scarring from strip surgery has become rare. FUE has certainly been proven to work. But personally I'm still not confident that it has as high a successful growth rate as strip surgery when done properly performed using microscopes. FUE also typically costs more for the amount of hair transplanted. Many of the leading physicians recommended on this community offer both and patients and their chosen physician can decide which technique is best for them. BHT (Body Hair Transplantation - body hair to head) is newer and, in my opinion, lacks the depth of evidence to fully determine its true rate of success both short term and long term. However, I think all of us would like to believe that it will ultimately be successful. Clearly for some of Dr. Umar's patients it already has been life changing success. However an enormous amount of work and tedious extraction was required to achieve these results. I believe Dr. Umar is genuine in his commitment to making BHT a proven success. Perhaps his extensive experience he enabled him to now have a high rate of success in appropriately selected patients. However, I think it is fair to error on the side of being conservative and give Dr. Umar and his patients more time to share evidence of both their successes and also the results that may not be as hoped for on this forum. I hope that in the near future Dr. Umar, even without formally being recommended, garners patients from this forum who are appropriate candidates and yield great results. I'm willing to be patient and I think this community is willing to be patient and watch and see as well. I trust that given Dr. Umar's strong belief in BHT and FUE that he will persist in continuing to present evidence of his work. In the mean time, I would really appreciate Dr. Umar sharing his assessment of the success rate of his BHT procedures to date as well as the long term characteristics of his patients' hair and its typical growing cycles. Let's all take a deep breath and relax and let the evidence continue to unfold. I look forward to learning much from Dr. Umar and his patients in the coming weeks. So be good to each other out there and don't pull on each others hair, because all hair, body or scalp, is precious ;-) Hairy Springer

Dr. Feller, I appreciate your input and the concerns you have expressed. I have long shared your concern that FUE and BHT not be oversold, as it certainly was by physicians other than Dr. Umar. I would never present Dr. Umar's BHT/FUE procedure on this site as a mainstream alternative for patients with good scalp donor nor would Dr. Umar. One of the reasons I'm impressed with Dr. Umar, in addition to his dedication and skill, is his honest presentation of the benefits and limitations of his procedure. With tens of thousands of hair loss sufferers visiting this community each week, some of them need an alternative to conventional strip surgery. In my opinion, Dr. Umar can serve this niche. I think there should be a place for him and his procedure on this broad based community. For those in particular who have been "through the mill" and have no other options for restoring a natural look other than using body hair, I'd like to be able to provide them with a viable option. As long as these patients have a realistic understanding of the pros and cons of this procedure and its risks and limitations, I think it is time to make it available and known. Best regards, Pat

Given Dr. Umar's impressive work and his willingness to actively participate on this community I think he deserves serious consideration for recommendation. I have created a topic entitled " Potential Recommendation of Dr. Umar". Those who would like to comment on his possible recommendation, please visit that topic and comment. Thanks for everyone's input. Pat

Dear forum members, We'd like to gather your input and opinions regarding the potential recommendation of Dr. Sanusi Umar of Redondo Beach, California on the Hair Transplant Network. Dr. Umar has established a reputation for being arguably the world's foremost expert on BHT (body hair transplant ??“ transferring body hair follicles to balding areas of the scalp). In recent weeks he has presented numerous examples of his BHT procedure on this forum (see below for links to these photo albums), in which patients who had depleted scalp donor hair, achieved remarkable improvement with body hair transferred to their scalp. His patients have also come forward to present their impressive FUE results. In an effort to learn more about BHT, I recently visited with and observed Dr. Umar performing his surgery. I was very impressed with his work and Dr. Umar's dedication to personally doing all the tedious FUE/BHT work at very modest prices. See the highlights from my visit to Dr. Umar's office, click here. Dr. Umar developed a passion for alternative hair transplant procedures due to a botched 400 graft strip surgery he endured years ago. His personal dedication has helped motivate him to excel while enduring unfair criticism from some of his BHT competitors. Dr. Umar has a background in dermatology and has been perfecting FUE and BHT procedures since 2005, with over 150 BHT procedures performed to date. Recognizing that not everyone is suited for BHT, Dr. Umar uses very strict criteria in determining who is an appropriate candidate. In Dr. Umar's experience more body hair is required to provide the same amount of coverage as normal scalp hair, due to the long resting phase of body hair. Dr. Umar often takes a comprehensive approach by creating a unique blend of scalp hair and body hair used as "filler" when appropriate. Dr Umar also extracts and places all FUE and BHT grafts himself. Using a 0.9 mm or less punch, Dr. Umar first scores the skin and then uses a needle to separate the root of the follicle from the surrounding tissues. Dr. Umar believes this process reduces scarring and minimizes the risk of transection that might result if he attempted extend the punch down to the base of the follicle for extraction. In my opinion, Dr. Umar's use of BHT gives qualified patients with depleted scalp resources a viable alternative in restoring their hair and he should be considered for recommendation. Dr. Umar's Patient and Surgical photos can be found below: 15000 BHT and FUE Hybrid for a NW6 at 9 months with Video 10000 BHT Extreme Repair Case with Video 3000 FUE and BHT Hybrid at 7 Months 22000 Grafts (15000 body, 6000 beard, 1000 head) Repair Case at 6 Months 3000 Grafts via Scalp FUE 600 Grafts via Scalp FUE Additional Photos Added by Request 1200 Grafts scalp FUE - African American Male - 8 Months I welcome input and comments from forum members regarding his potential recommendation. To view our standards for recommendation, click here. To learn more about this communities process of prescreening physicians, click here .

Hairthere, I appreciate your reply. Bill and I are very open to hearing the good, the bad and the ugly about all doctors, including those who may be in the Coalition. In the past three years I have removed over a dozen doctors from the recommendation list. Most of the time this was not known online. They were simply removed with no fan far. In some cases they were removed based on patient comments or in other cases after I visited their clinic and found it was not what it should have been. We add doctors as a community and we can remove them the same way. Just keep in mind that there are 700 members of the International Society of Hair Restoration Surgery and at least that number of physicians again who are not members but who perform hair transplant surgery. The Coalition has thirty four physician members who in my opinion and based on all the evidence I could gather in ten years are the true cream of the crop. They represent only 2.5% of all doctors performing hair transplantation. Are they perfect, of course not. Will some patients prefer some of them over others, absolutely. But I do believe they are all truly some of the very best. However, none of them can rest on their laurels. They must continue to evolve and operate transparently knowing that any one of their patients can and often does report back on this forum about their experience. There is no regulation in this industry. The closest we have is patients holding this web community and all doctors accountable to the highest standards.

hairthere, If you want to play armchair quarterback and make blanket statements that you're not willing to back up then don't make them. Have you spent years on the road visiting well over 50 clinics in North and South American and Europe to assure that those in the Coalition do in fact provide outstanding work? Do you get hundreds of private reports from actual patients each year? Do you attend all the major scientific meetings? No, I didn't think so. But you view photos from a minority of doctors who post online and now you see the big picture? We expect the doctors to be accountable for what they do. We should also expect those with posting privileges to be accountable for what they say. Provide the names of those Coalition members you think are "marginal" or shut your pie hole. Pat

Newgrowth, Welcome to our community. A big congratulations on your great transformation and kudos to you for surviving the ordeal you went through prior to Dr. Umar. I hope you become a regular member of our community. Feel free to create patient weblog documenting your journey if you'd like. I'm curious. How does your body hair feel, manage and grow on your scalp? Does it feel and grow like your regular scalp hair? How far does it grow in length? You are certainly on the cutting edge of new procedure. Best wishes for continued growth and for enjoying life to the fullest. Pat

Bradman, By all means keep your consult and go in with wide eyes and see it all for yourself. He has a photobook that you can view that has impressive results. It's just that the photos tend to be the traditional front view before and afters. The online patient community tends to want to see multiple angles and immediate post op photos. Keep us posted. Pat

Arrie, Yeah, guys like you who run off and get on with their lives and forget to update us are really a problem. Bill and I have toyed with the idea of hiring a guy named "Vinny" to make the rounds and check up on guys like you. If things got real ugly Vinny would drop hints about how his Indian grandfather had tought him how to scalp a man. Lucky that you came back. Now if you create a patient blog I think all can be forgiven. Congratulations on getting your hair back. But don't forget about the poor bastards who are still wandering through the wilderness of snake oil and TV infomercials :-)

Bradman, Welcome to our community. We can all relate to the long slow loss of our hair and youth. But as you know, if you choose wisely you can restore your hair, if not your youth. A couple of months ago I was visiting clinics in the San Fran area and I did observe Dr. Rosanelli's surgery ( view the full highlights here). Overall I was impressed with his work and his large and experienced staff. I did invite him to present photos of his results on this community so that he could be considered for recommendation. But his before and after photos failed to sufficiently impress the members of this community to garner formal recommendation. I think his office is not up to speed in photographing and documenting their patients. Bill and I have encouraged them to buy a professional camera and lighting so that they can take decent documentation of their cases, including immediate post ops, which they have not been doing. I hope that they do get up to speed and provide compelling photos that are on pare with what we all see every day on this forum. My sense is that Dr. Rosanelli is out of the online loop and does not see the quality of photos that are posted online and that we are all accustomed to. Thus while his work may be impressive, his documentation is weak. It's a shame since we really are prescreening physicians for their surgical skill not photographic skill. But the members of this community deserve to see compelling results before granting formal approval. I hope that he moves forwarded into the digital online age and starts taking and presenting compelling photos online. We shall see. Best wishes, Pat

Please Grow Please, I hear your concerns. I will email Dr. Umar to provide more information about his philosophy and to encourage him to provide more examples of straight FUE work. My sense is that he has recently posted the most difficult cases that a physician can encounter and that standard FUE would be less challenging. But I agree that we should hear more from him about his overall philosophy and see more of his work. Thanks for your thoughtful input. Pat

Thanks for everyone's thoughtful input. Given what we have all seen of Dr. Umar's work and technique I think it is time to put his potential recommendation out to this community in a topic dedicated to gathering everyones input. Personally I think it would be great to have him in our Network for those mission impossible cases in particular. Pat

Excellent Question. Having observed surgery at dozens of leading clinics, it is surprising that there is not one predominant school of thought on the optimal donor closure technique. Some physicians argue that using internal sutures below the surface of the skin in the subcutaneous tissue will reduce the tension on the skin that is sutured by an external skin layer suture. This technique is typically referred to as a "double layer closure" and can be used with or without the trichophytic closure. Typically the internal sutures are disolvable, while the external skin layer sutures need to be removed. Other physicians argue that internal sutures should only be used when the donor area is particularly tight due to either low scalp laxity and or a wide strip being removed. They claim that internal sutures, which can take over a month to dissolve, can potentially create reactions or irritations, although very rare, under the scalp. Other physicians choose to use staples rather than sutures because they believe that the staples are more secure and do not bind on the skin or strangulate the skin like sutures might. As for the trichophytic closure, it is a nice final touch that can help disguise the final donor scar by having the hairs grow up and through the scarline. But if the scar is wider than pencil thin it really will have only marginal value. Thus it is no replacement for doing a fundamentally sound closure. Some doctors opt not to perform a tricophytic closure when they expect the patient to do more sessions because they believe that that the tricophytic closure can result in follicles along the scarline becoming some what contorted, which can make them harder to trim into viable grafts. At the upcoming annual ISHRS meeting of hair transplant physicians in September, the appropriate implementation of the trichophytic closure is a dedicated topic. It will be interesting to hear the pro and con debate. Personally, having had both sutures and staples, and seen dozens of surgeries and results, I believe the double layer closure with tricophytic closure is optimal. I've always been impressed at how easily the skin comes together with virtually no tension when underlying internal sutures are used. Thus there is virtually no binding or tension on the external sutures. The underlying internal sutures also remain in place for much longer than ten day and thus minimize the danger of donor scar stretching. Sutures are also much more comfortable, especially during their removal, in my experience and from what I have heard from dozens of other patients. A double layer suture with trichophytic closure takes the most time of any closure technique. But in my non MD opinion, it is the most comfortable and optimal closure technique for the patient.

Ten years ago when I began working with patients online, hair disasters were all too common. Fortunately, the standard of care and techniques used have evolved vastly, in large part due to educated patients demanding only the best. The multiple flap and scalp reduction surgeries that this patient endured are largely relics of the past - thank God. I can only imagine the misery and pain that this patient has endured. Big kudos to Dr. Umar for doing the very tedious work of restoring this person's normal look and his life. I look forward to seeing how this patient does long term and how the hair growth cycles of his body hair affect his appearance on an ongoing basis. While this case is very impressive, I would like to know what percentage of Dr. Umar's patients achieve cosmetically significant growth. Based my conversations with him in his office, his success rates are high. It is beginning to look like BHT will have a real place in helping to restore patients with limited scalp donor hair and that Dr. Umar is the leading practitioner of BHT. At some point I would like to formally present Dr. Umar to this community for consideration for formal recommendation. I think the unique procedure that he offers would supplement the standard strip and FUE that most of the leading physicians currently offer. Any thoughts whether we should at this time formally recommend Dr. Umar and his BHT work on the Hair Transplant Network? I have visited his clinic ( view highlights ) and we have seen multiple examples of his successes. Do we need to wait for more evidence or is it time to welcome him aboard? Onwards and Upwards, Pat

As B Spot pointed out, the issue of the future growing cycles of body hair when transplanted to the head is a major concern. My understanding is that body hair when transplanted to the head continues to be characteristically dormant much more of the time than native scalp hair. Dr. Umar has been up front about this and tells his patients that more body hair is needed to produce the fullness one can get from scalp hair. He also likes to mix scalp and beard hair with body hair, with the body hair acting more as filler hair. Perhaps Dr. Umar could share his expertise and experience on this issue. I'll drop him an email and ask him to reply. Best wishes, Pat

Way back in 2001 I did watch Dr. Wentland do surgery. At that time he was using dilators, which are essentially small finishing nails he used to hold the graft incisions open. He also was not using magnification to prepare the grafts. All in all, I was not impressed and was not about to recommend him at that time. Now seven years later I have no idea what procedure or technique he is using. But I certainly hope that he has given up the dilators and adopted state of the art techniques. Below is my original post from Posted August 22, 2001 01:37 PM

Bruce65, Welcome to our community. I'm glad that this community has been helpful to you. I think you chose to consult with some excellent physicians. I have had the privilege of seeing all of them perform surgery and I think they are all good choices. You have the good fortune of having many excellent choices. Some of these physicians are formally recommended by this community and others like Dr. Ross and Dr. Mohebi are seriously being considered for recommendation in the future. I think you will do just great with Dr. Mohebi. But I have not presented him to this community for formal recommendation yet since he does not have access to his past before and after photos to present publicly. But in time, I expect he will present many impressive photos (maybe even yours :-) and will win the respect of this community and be formally approved for recommendation. To see the highlights from my tour of clinic in Southern California, including Dr. Mohebi's office, click here. Typically everyone is more comfortable going to those physicians who have provided demonstrated and consistent results over the years on this community. That's human nature and it's also required before new doctors can earn their stripes. Keep us posted on your surgery and do consider creating your own patient weblog to document your hair restoration journey and get feedback and support from our members. Best wishes for a great result, Pat

Gorpy, You've helped a great deal of people on this forum over years. The least I could have done is poured a few beers down you. Sorry I didn't think of it. Let's chalk it up to sun stroke. But the good news is that I may be able to do much better by you soon. We will be hosting a 10th anniversary party for the Hair Transplant Network at the annual ISHRS meeting in Montreal the first week of September. Obviously the Hair Transplant Network would be nothing without hardcore hair vets like you so you will be on the VIP list. I haven't announced this party on the forum yet so consider yourself the first to be invited. It's going to be great to have top notch doctors and hard core forum members meeting and enjoying a great time in person. It's long over due! Onwards and Upwards, Pat

As some of you know, I regularly visit leading clinics to observe the quality of their surgery and meet with their patients. Those visits that are positive are featured on this forum at Visits to Leading Hair Transplant Clinics. During these visits I always learn some new pearl of wisdom. Recently while visiting Dr. Shelly Friedman's clinic in Scottsdale ( view highlights here ), he shared his post op regimen with me. He claims that when his patient's apply Polysporin Ointment on their recipient area four times a day for four days they get virtually no scabbing or redness five days after surgery. In his opinion as a long time dermatologist, patients who follow this regimen have recipient areas at five days that are as clean as what would normally take ten days. A tube of Polysporin Ointment can be purchased over the counter for next to nothing. I suggest that all patients no matter who their surgeon, discuss this possible post op treatment regimen with their physician. Best wishes to every one for rapid healing and outstanding growth. Pat

As some of you know, I regularly visit leading clinics to observe the quality of their surgery and meet with their patients. Those visits that are positive are featured on this forum at Visits to Leading Hair Transplant Clinics. During these visits I always learn some new pearl of wisdom. Recently while visiting Dr. Shelly Friedman's clinic in Scottsdale ( view highlights here ), he shared his post op regimen with me. He claims that when his patient's apply Polysporin Ointment on their recipient area four times a day for four days they get virtually no scabbing or redness five days after surgery. In his opinion as a long time dermatologist, patients who follow this regimen have recipient areas at five days that are as clean as what would normally take ten days. A tube of Polysporin Ointment can be purchased over the counter for next to nothing. I suggest that all patients no matter who their surgeon, discuss this possible post op treatment regimen with their physician. Best wishes to every one for rapid healing and outstanding growth. Pat

Kaelen, At the time of your post we really didn't know much about Dr. Friedman. He also has no website at present and very little presence on the Web. However, I was just recently in Arizona visiting leading clinics and was very impressed by the work Dr. Friedman is now doing. To view the highlights from my visit, click here. To view my report on Arizona in general, including my visit to Dr. Alexander's clinic, click here.

PleaseGrowPlease, You certainly have an eye for detail and can spot a clown wearing suspenders from afar. But I encourage you to take a closer look at Joe and Bill and look for signs of glue or tape seeping out from around the edges of their hair. Bill, apparently you forgot to take your wig with you on your latest orbital venture. Or did your hair disappear into a black hole around your head?

Ok, ok, I'm voluntarily disqualifying myself because I can't continue to live with a lie. It's a hair system. There I said it. I just felt a lot of pressure to compete with Bill and Joe and so I cheated. I throw my self on the mercy of this community and beg for forgiveness. I trust that Bill and Jotronic would do the same if it were not their real hair.

Dr. Umar, Thanks for sharing this impressive case with our community and with me when I visited your clinic in Redondo Beach California recently. Like many members of this community, I have also been a BHT (Body Hair Transplant) skeptic, largely due to this procedure being over sold and over priced by clinics other than yours. However, having learned more about you and your dedication to personally doing such tedious FUE/BHT work at very modest prices, I think you provide a very valuable service in particular to patients like the one in this video who have no other options. I was also impressed by the BHT/FUE presentation you gave to your colleagues at the last ISHRS annual scientific meeting. You presented BHT results without over selling their benefits, while pointing out the limitations. Kudos to you for doing this extremely tedious work from A to Z personally and at very modest prices, while suffering unfair criticism from some of your BHT competitors. Congratulations to this patient who no doubt experienced a personal Hell prior to you. I look forward to sharing more information about you in my upcoming "Visits to Leading Clinics in Southern California".