Pat - Community Publisher
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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
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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
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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
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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.
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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
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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
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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
Well, I just got back from visiting Chicago and made a point of researching what I hoped would be some of the better physicians.I met with Dr. Wentland, former Elliot and True surgeon, and saw him do surgery on Saturday.
Dr. Wentland had his hair restored by Dr. Elliot and his results looked fairly good. Not quite in league with what I'm use to seeing with Shapiro and his group and others on his level - but good.
It was interesting to see the use of dilators in action. Basically dilators are actual small nails that have specially shaped points that are placed into the recipient incisions to hold them open until the grafts are placed. Dilators are only used by a minority of clinics including most of Elliot and True.
Dr. Wentland is convinced that dilators make placing the grafts easier and thus less damage occurs to the graft.
It was a strange sight seeing a patient with dozens of small nails sticking out of his head.
In my opinion this method is not as refined or artistic as a skilled surgeon working with an assistant making tiny close incisions that are immediately filled with a graft - technique called "Sticking and placing".
He also did not use magnification during the graft dissection process.
Ultimately I felt his end results, looking at his assistants hair and photos, were ok - no cobble stoning or pitting and good reported growth rates - but not as naturally distributed or refined as what I've come to expect from a top surgeon.
All the other clinics I intialy contacted also did not really impress me.
But if anyone has found a clinic in the Chicago area that does impress them please let me know.
Lets keep those doctor reviews coming. Pat
Thanks for reading this post. But it's your posts that make this discussion group real and vital. Please register - it's free and easy - and then jump into the discussion.
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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
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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
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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
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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
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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.
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After considerable research and patient feedback over the years, I believe there are three outstanding clinics in Arizona that provide world class hair transplant procedures and results.
In my opinion they are Dr. Sharon Keene in Tucson, Dr. Scott Alexander in Phoenix and Dr. Shelly Friedman in Scottsdale.
Dr. Keene has been recommended on the Hair Transplant Network for years and is a founding member of the Coalition of Independent Hair Restoration Physicians. She has earned consistently excellent reviews on our forum for her personal service and results.
Unfortunately, she was not performing surgery during the time I was in Arizona and so I was not able to view her surgery. However, I have watched her perform surgery in the past when she worked at the Shapiro Medical Group in the Twin Cities. It was clear that she ran a tight ship and demanded the very best of herself and the staff.
Dr. Scott Alexander has been recommended on the Hair Transplant Network for a number of years and is a member of the Coalition of Independent Hair Restoration Physicians. In recent years his strong dedication to performing ultra refined follicular unit grafting with great results has earned him a loyal and enthusiastic following. He has not only performed great work but also done a good job of documenting his surgeries and presenting them on this forum.
Given his excellent reputation on this community, my visit to his clinic only confirmed what we already know, which is that Dr. Alexander and his staff perform ultra refined follicular unit grafting at the highest level of skill and commitment. To view the highlights and photos from my surgical visit, click here .
If visitors click on the "Find" feature on this forum and do a search using either "Keene" or "Alexander" they will find numerous excellent patient reviews along with compelling results.
I was fortunate on my tour of Arizona to find one more gem amongst the rough, Dr. Shelly Friedman. Although he has not been active online or with this community, Dr. Friedman has garnered some favorable patient reviews on this forum community.
However, I was impressed with his credentials, experience and surgical technique when I recently visited his clinic. I had an opportunity to observe he and his very experienced staff performing ultra refined follicular unit hair transplantation and it was obvious that he has stayed current on the most recent advances. I have invited him to present examples of his patient results on this community in order to be considered for recommendation.
To view the highlights and photos from my surgical visit to Dr. Friedman's clinic, click here.
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Dr. Mejia,
Thanks. It was a pleasure visiting your clinic in Jupiter, Florida in January and seeing your impressive surgery and the passion you and your staff have for doing outstanding work.
Unfortunately, my computer with the photos from my visit was stolen soon after my visit with you.
I feel bad that you have not gotten the recognition you deserve from my visit. Your work really impressed me and you deserve to be featured along with the other leading clinics I have visited.
Could you document one of your more impressive surgeries - i.e. 2,500 plus grafts with dense packing so I can feature your surgery? I suggest you view Dr. Meshkin's visit to get a sense of the type of photos and details I will need.
I look forward to helping people learn more about you and your impressive work.
Pat
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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?
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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.
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Despite Southern California's reputation for beautiful people, there are a surprisingly limited number of truly world class hair transplant physicians.
I have visited hair transplant clinics in Southern California on at least three occasions over the past several years to determine who to recommend on the Hair Transplant Network.
Almost two years ago during the fall of 2006, I had the privilege of meeting with several physicians and observing their surgeries. The standouts in my opinion were Dr. Bill Reed of La Jolla, Dr. Ken Siporin in LA and Dr. Bill Rassman in LA. To view the photos and highlights from my surgical visits click on their names.
Since that time Dr. Reed and Dr. Siporin in particular have garnered excellent patient reviews on this forum, which have confirmed my positive first hand impressions.
In May of 2008 I returned to Southern California to evaluate a few other promising clinics. Given my confidence in the work being done at the clinics I visited in November of 2006, I focused my recent visits on observing the surgery being done by other promising clinics.
The clinics I visited in May of 2008 that I thought were performing impressive hair transplantation include:
Dr. Michael Meshkin in Newport Beach
Dr. Tim Carmen , Associate of Dr. Bill Reed, in La Jolla
Dr. Brandon Ross in San Diego
Dr. Sanusi Umar in Redondo Beach
Dr. Parsa Mohebi in Los Angeles
Click on the physician's name to view the highlights from my visit, including photos of their surgery.
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It's always exciting for me to discover an up and coming hair transplant physician. In my opinion, Dr. Para Mohebi is such an up and comer. I expect he will become well known in the coming months and years online for his quality follicular unit grafting.
Last year Dr. Mohebi completed a one year hair transplantation fellowship with Dr. Bill Rassman at NHI where he did a large number of surgeries. Then in January of 2008 he opened his own clinic, US Hair Restoration.
Since he does not have the right to publicly present the results of his surgeries performed while at NHI clinic, he presently has a limited number of before and after photos that he can show. However, I expect to see many impressive results from his office presented on this forum in the coming months and years.
Dr. Mohebi impressed me as being passionate about his work and dedicated. He has succeeded in attracting a skilled and experienced staff. On the day I observed surgery in his office two of the medical technicians on duty had 13 years experience and a third had nine years experience in hair transplantation. He and his experienced staff have the capability to do sessions exceeding 3,000 grafts.
In addition to performing state of the art follicular unit hair transplantation, he also performs FUE (follicular unit extraction) with sessions up to 1,500 grafts a day.
Dr. Mohebi uses 20 gauge needles to make tiny graft incisions as small as 0.7mm. He told me that he intentionally zig zags his donor excision slightly so that the thin donor scar is harder to detect even under close examination. He uses a double layer closure when he feels it is needed to minimize any potential scaring. He uses staples of the external suture.
In the past Dr. Mohebi has had a strong interest in researching hair growth, hair multiplication and wound healing. He currently collaborates with academic centers on studies on hair growth, gene therapy techniques and hair multiplications.
During my visit they performed a 1,948 follicular unit graft session to restore the patient's hairline. The 1,948 grafts consisted of 319 ones, 1,541 twos and 85 threes and 3 four hair grafts for a total of 3,678 hairs.
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In November of 2006, when I visited Dr. Bill Reed's office, Dr. Tim Carman was nearing the completion of his one year fellowship in hair transplantation (to view the highlights visit http://www.hairrestorationnetwork.com/eve/showthread.php?t=146822 . Dr. Carman had an impressive background and had the good fortune to work with and learn from one of the very best hair transplant physicians in the world, Dr. Bill Reed.
Given Dr. Carman's strong background in plastic and reconstructive surgery and his artistic talents he was a natural at hair restoration and has since joined Dr. Reed's practice, La Jolla Hair Restoration. Dr. Reed also entrusted Dr. Carman with performing his last hair restoration procedure. Dr. Carman is a native of La Jolla.
Dr. Tim Carman shares Dr. Reeds philosophy of putting the patient's best interest above technical dogma and as well as his intense compassion and commitment.
In addition to a medical background that includes experience in plastic and reconstructive surgery, Dr. Carman has a strong interest in painting, sculpting and music composition. He enjoys the artistic aspects of hair transplantation and his careful attention to detail was very evident when I watched him perform surgery.
On the day of my visit, Dr. Carman performed a crown restoration surgery in which he carefully recreated the crown whirl. He, like Dr. Bill Reed, used very small needles to create incisions as small as 0.7mm.
Dr. Carman took a great deal of time and care in removing a long and narrow donor strip, which measured 28 cm long by 1 cm wide. The donor density was lower than average and yielded 2,066 follicular unit grafts - consisting of 398 ones, 1,459 twos and 209 three and four hair grafts. The experienced staff then placed these grafts into the crown area.
Dr. Carman performed a trychophytic closure using the beveled ledge technique advocated by Dr. Paul Rose. The closure and surgical pattern of the grafts was excellent in my opinion.
Overall I'm impressed with Dr. Carman's passion and commitment to hair transplantation. I also appreciate his active sharing of his expertise on our discussion forum. I look forward to seeing many examples of his impressive results in the months and years to come.
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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".
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Hold your horses you upstarts. This old horse would like to enter my results into this top level contest.
For hair direction in all directions, lift, density and audacity I think I've got what it takes to cinch this showdown.
Sure I'm using some multi colored volumizing hair spray. But it's the END RESULT that matters, right?
Not to be catty, but between choosing a terrorist and a Carrot Top want a be, I think the choice is clear. But I leave it to the good judgment of our forum members to make the RIGHT choice.
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Mike,
I do take the hat off when I go to bed and in the shower. I guess the vote count does say loose the hat. I may need to supply an updated photo.
Pat
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Recommending Physicians: A Collaborative Effort
Physician Selection is Critical
The most important decision a patient will make is their choice of physician. The skill, talent, and experience of hair transplant physicians and their staff varies widely, as do the life long results.
It's critical that patients choose a physician who has a proven track record of providing truly state of the art results.
This Community is Run by and for Patients
This online community was created by and for hair transplant patients. For the publisher's hair restoration story, click here.
All the physicians who are recommended on the Hair Transplant Network have been carefully screened by patients and must meet our community's high standards. To view all the physicians who are recommended on this community, click here.
Our Collective Wisdom Determines the Recommendations
This recommendation process is collaborative and involves input from the thousands of patients who have visited our community over the past 20+ years. Their actual experiences have helped determine which physicians are recommended or not.
In addition to patient input, the publisher of this community, Patrick Hennessey, regularly visits leading clinics around the world to observe their surgeries, meet with their patients and evaluate the physician, staff and clinic.
Prior to any physician being recommended information about the physician, including multiple examples of their surgical process and patient results, are presented on this forum community. Forum members and leading hair restoration physicians are invited to post their comments and critiques.
Our goal is to enlist as much input as possible from multiple patients before making a determination about a physician. We strive to make this evaluation process as democratic and transparent as possible. We hope that you become an active member of this community and contribute your input to this collective process.
To view an example of this review process on our forum click here.
Those physicians who are chosen for recommendation based on their merits contribute a monthly sponsorship fee to pay for the cost of running this community.
Meeting an Ultra High Standard - the Coalition of Independent Hair Restoration Physicians
Those physicians whose clinics have developed the capacity to provide large sessions exceeding 2,500 follicular unit grafts and the skill to perform ultra refined high density sessions are eligible for membership in the Coalition of Independent Hair Restoration Physicians . To read about the ultra high standards for membership, click here.
All Recommended Physicians Must Meet Our Standards Continually
All recommended physicians are expected to continually meet our high standards on an ongoing basis. Patients are encouraged to share their experiences both good and bad. Those physicians who fail to provide consistent high quality results will have their recommendations discontinued.
We hope that you benefit from the collective wisdom of this patient based community and contribute to it.
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I visited Dr. Mohebi's clinic last week and I was very impressed by the work I saw him and his very experienced staff doing. I invited him to share his work on our forum and I'm glad to see that he has begun to do this. Although I agree that more details would be useful, including the total number of hairs.
I will soon be sharing what I observed and learned while watching he and his staff perform surgery last week. But in general I was very encouraged by what I saw. Dr. Mohebi did a one year fellowship with Dr. Rassman at NHI in LA and I understand did a large number of surgeries during that time. He recently opened his own clinic but does not have or can't use the photos from his surgeries while at NHI.
I expect to see him posting many impressive results over the coming months that will confirm the high quality work I saw when observing his surgery last week. I should have the highlights from this visit posted soon at the "Visits to Leading Hair Transplant Clinics" forum at http://www.hairrestorationnetwork.com/eve/forumdisplay.php?f=101
Deserter of the Bretheren.....
in Open Hair Loss Topics
Posted
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 :-)