Pat - Community Publisher

Thanks for everyones feedback and input. I'm convinced that the Farjos have met the challenges of evolving their techniques to provide truly world class and ultra refined hair transplantation. I also want to thank Mick, the clinic's patient educator, for providing impressive evidence of the Farjos state of the art work. I'm pleased to announce that both Drs. Bessam and Nilofer Farjo have been granted membership in the Coalition of Independent Hair Restoration Physicians. I agree that it's great news that people in the UK have a world class choice right in their back yard. Best regards, Pat

Thanks for everyones feedback and input. I agree that Dr. Williams has shown his willingness to stand behind his work and patients and operate in a transparent online environment. I believe he has truly earned the trust and confidence needed to restore his membership in the Coalition of Independent Hair Restoration Physicians. So I'm pleased to announce that he has been granted membership in the Coalition. Best regards, Pat

Leander, If you are in Ireland you may want to also check out Dr. Kiely. I was going to visit his clinic earlier this year to observe his surgery but the trip was canceled due to him having a family emergency. I know Dr. Kiely's prices are much more reasonable than Dr. Collins (who charges at least twice that of the very best clinics in North America). But I can't vouche for Dr. Kiely or his work at this point. Dr. Ron Shapiro is without a doubt outstanding. Just use the "Find" feature on this forum to search for "Shapiro" and you'll see what I mean. Best wishes, Pat

Ok, by popular demand Bill is now officially a "Follicular Grand Wizard" with over 5,000 posts (notice his new name above his smiling face). So I guess we should all get together while Bill acts as the Follicular Grand Wizard and burns a bad hair piece in effigy. Congratulations Bill. Thanks for your enormous contributions to this community. Pat

While this forum is wide open to patients sharing their good and bad experiences with all physicians, it is not a vehicle for certain posters to maliciously libel a respected physician without providing any evidence. Given that physicians are bound by law and medical code not to divulge their patient information it is hard for a physician to defend themselves online when a patient makes accusations. In my opinion, the poster known as DaveJoseph took advantage of this and maliciously attacked Dr. Jennifer Martinick on our forum and others. Many members who read his posts and realized his agenda asked that his posting privileges be removed. I want our forum to be fair and enable both sides of a debate to present their views. However, this did not occur on the topics posted and stoked by DaveJoseph. Thus in my opinion Dr. Martinick was unfairly libeled and maligned on our forum. I apologize to her for not addressing this issue sooner rather than letting this lopsided discussion continue. I know Dr. Martinick to be very passionate about doing quality work and caring for her patients. Until DaveJoseph can provide evidence (photos) to support his claims his posting privelages have been suspended. His one side topic will also be locked until a fair and two side account of this issue is available. I apologize to the members of this community for not doing this earlier. Best regards, Pat

While this forum is wide open to patients sharing their good and bad experiences with all physicians, it is not a vehicle for certain posters to maliciously libel a respected physician without providing any evidence. Given that physicians are bound by law and medical code not to divulge their patient information it is hard for a physician to defend themselves online when a patient makes accusations. In my opinion, the poster known as DaveJoseph took advantage of this and maliciously attacked Dr. Jennifer Martinick on our forum and others. Many members who read his posts and realized his agenda asked that his posting privileges be removed. I want our forum to be fair and enable both sides of a debate to present their views. However, this did not occur on the topics posted and stoked by DaveJoseph. Thus in my opinion Dr. Martinick was unfairly libeled and maligned on our forum. I apologize to her for not addressing this issue sooner rather than letting this lopsided discussion continue. I know Dr. Martinick to be very passionate about doing quality work and caring for her patients. Until DaveJoseph can provide evidence (photos) to support his claims his posting privelages have been suspended. His one side topic will also be locked until a fair and two side account of this issue is available. I apologize to the members of this community for not doing this earlier. Best regards, Pat

I recently visited Dr. Williams and his staff as they performed a truly ultra refined procedure in their Henderson office in the Las Vegas area. I found the high quality and refinement of their work impressive. To see the photo highlights from this visit, click here. After speaking extensively with the clinical staff it was obvious that they had extensive experience and took great pride in the quality of their work and patient results. Dr. William and his staff focus on one patient a day and have the capability to do 3,000 graft sessions. I also had the chance to see a number of Dr. Williams' patients in person who came into his office for follow up. Their results were very natural and their growth and density was impressive. Their donor scarring was also very minimal and of no cosmetic significance. In my opinion, the work and results being done by Dr. Williams and his staff are truly ultra refined. Dr. Williams has been recommended on the Hair Transplant Network for the past three years. Click here to view his current profile and patient photos. Dr. Williams has a strong surgical background and has been performing follicular unit hair transplantation exclusively for the past seven years. Given his credentials, experience and the ultra refined technique that he performs I believe he should be granted membership in the Coalition of Independent Hair Restoration Physicians . To view the membership standards for the Coalition, click here . At my request, Dr. Williams' office has posted several examples of their patients' results, including Dr. Williams own hair transplant photos. Click here, to view these patient results. In encourage the members of the community to review these results and share their input on this topic regarding Dr. Williams potential membership in the Coalition. Best wishes, Pat

I recently visited Dr. Williams and his staff as they performed a truly ultra refined procedure in their Henderson office in the Las Vegas area. I found the high quality and refinement of their work impressive. To see the photo highlights from this visit, click here. After speaking extensively with the clinical staff it was obvious that they had extensive experience and took great pride in the quality of their work and patient results. Dr. William and his staff focus on one patient a day and have the capability to do 3,000 graft sessions. I also had the chance to see a number of Dr. Williams' patients in person who came into his office for follow up. Their results were very natural and their growth and density was impressive. Their donor scarring was also very minimal and of no cosmetic significance. In my opinion, the work and results being done by Dr. Williams and his staff are truly ultra refined. Dr. Williams has been recommended on the Hair Transplant Network for the past three years. Click here to view his current profile and patient photos. Dr. Williams has a strong surgical background and has been performing follicular unit hair transplantation exclusively for the past seven years. Given his credentials, experience and the ultra refined technique that he performs I believe he should be granted membership in the Coalition of Independent Hair Restoration Physicians . To view the membership standards for the Coalition, click here . At my request, Dr. Williams' office has posted several examples of their patients' results, including Dr. Williams own hair transplant photos. Click here, to view these patient results. In encourage the members of the community to review these results and share their input on this topic regarding Dr. Williams potential membership in the Coalition. Best wishes, Pat

This past spring I visited Drs. Bessam and Nilofer Farjo to observe them and their staff perform two impressive ultra refined surgeries over two days. It was apparent after watching their procedure and technique that they had successfully incorporated all of the most important recent advances in ultra refined hair transplantation. To see photos and highlights from this visit, click here. All of their grafts are carefully trimmed under microscopes and Bessam and Nilofer create all the carefully oriented and minimally invasive graft incisions using custom cut blades that are as small as 0.7mm. Their use of small incisions enables their patients to achieve greater density in a single session, while experiencing quicker healing. They take a team approach to the surgery with all hands on deck and working well together. Given the size and skill of the team the clinic can perform large sessions in excess of 3,000 grafts when appropriate for the patient. They typically limit themselves to one patient a day to achieve an optimal level of care. I also had the opportunity to see some of their patients in person and their results were excellent. In my opinion, their ultra refined technique and patient results are on pare with the top Coalition clinics in North America. To provide this community with examples of their excellent patient results, their patient educator, Mick McHugh, posted photo albums of recent patients. I appreciate him taking the time to do this. Please feel free to view some of these patient photo albums below: Hairline Restoration and dense packing with 2549 follicular unit grafts One session of 2030 follicular unit grafts Immediate post surgical images A variety of patient photos Both Dr. Bessam Farjo and his wife Dr. Nilofer Farjo have been recommended on the Hair Transplant Network for over five years. To read their current profiles click on their names. They both have outstanding credentials and have been very active in organizing and participating in various international hair restoration meetings. In my opinion, they are highly qualified and should be granted membership in the Coalition of Independent Hair Restoration Physicians . To read the Coalition membership criteria, click here . I welcome all input and opinions regarding the potential membership of the Farjos in the Coalition. All the best, Pat

This past spring I visited Drs. Bessam and Nilofer Farjo to observe them and their staff perform two impressive ultra refined surgeries over two days. It was apparent after watching their procedure and technique that they had successfully incorporated all of the most important recent advances in ultra refined hair transplantation. To see photos and highlights from this visit, click here. All of their grafts are carefully trimmed under microscopes and Bessam and Nilofer create all the carefully oriented and minimally invasive graft incisions using custom cut blades that are as small as 0.7mm. Their use of small incisions enables their patients to achieve greater density in a single session, while experiencing quicker healing. They take a team approach to the surgery with all hands on deck and working well together. Given the size and skill of the team the clinic can perform large sessions in excess of 3,000 grafts when appropriate for the patient. They typically limit themselves to one patient a day to achieve an optimal level of care. I also had the opportunity to see some of their patients in person and their results were excellent. In my opinion, their ultra refined technique and patient results are on pare with the top Coalition clinics in North America. To provide this community with examples of their excellent patient results, their patient educator, Mick McHugh, posted photo albums of recent patients. I appreciate him taking the time to do this. Please feel free to view some of these patient photo albums below: Hairline Restoration and dense packing with 2549 follicular unit grafts One session of 2030 follicular unit grafts Immediate post surgical images A variety of patient photos Both Dr. Bessam Farjo and his wife Dr. Nilofer Farjo have been recommended on the Hair Transplant Network for over five years. To read their current profiles click on their names. They both have outstanding credentials and have been very active in organizing and participating in various international hair restoration meetings. In my opinion, they are highly qualified and should be granted membership in the Coalition of Independent Hair Restoration Physicians . To read the Coalition membership criteria, click here . I welcome all input and opinions regarding the potential membership of the Farjos in the Coalition. All the best, Pat

At present no physician or clinic in Toronto is recommended on this community. I did visit Toronto a couple of months ago ( see the highlights ) to observer surgery at various clinics. A couple of clinics in Toronto are being considered for recommendation. Dr. Armani is not one of them. Personally, based on information that I have, I have serious reservations about Dr. Armani. In my opinion, Dr. Armani has been and continues to be over hyped online by his online agents. I'd take any plugs for him with a high degree of skepticism.

Ok, lots of good possibilities. But putting "Dr" in front of Bill' could result in too many patients showing up at his door step seeking surgery. Since no one is even close to joining the exulted 5,000 plus mark, it can hardly be designated as a "club". I think we should just anoint Bill as forum king, grand pubba or grand wizard. Dr. Feller's suggestion of "Grand High Exulted Mystic Ruler Club Member" got me thinking in terms of "grand" and "exulted". How about some very exulted sounding titles like - "Follicular Grand Wizard"?

Bill has once again left the rest of us mere mortal members in the dust. He has gone way past the 2,000 posts required to be a "Celestial Follicle Club Member". Bill has now written over 5,000 helpful posts! This doesn't even include the hundreds of emails he has thoughtfully answered or the dozens of great articles he has written for our Q & A Blog. I think we need to create a new category for Bill and any other super heros who manage to post over 5,000 posts. I'm at a loss for what is even more elevated than "Celestial Follicle Club Member". I need help from members to come up with a such a category. Of course, let's be careful not to create a title that trumps God himself or Bill may suffer his retribution. We can't afford to loose him. Please post your suggestions below. Thanks, Pat

Bill has once again left the rest of us mere mortal members in the dust. He has gone way past the 2,000 posts required to be a "Celestial Follicle Club Member". Bill has now written over 5,000 helpful posts! This doesn't even include the hundreds of emails he has thoughtfully answered or the dozens of great articles he has written for our Q & A Blog. I think we need to create a new category for Bill and any other super heros who manage to post over 5,000 posts. I'm at a loss for what is even more elevated than "Celestial Follicle Club Member". I need help from members to come up with a such a category. Of course, let's be careful not to create a title that trumps God himself or Bill may suffer his retribution. We can't afford to loose him. Please post your suggestions below. Thanks, Pat

I have reservations regarding Dr. Mark Distefano due to his continued use of a multi bladed knife for removing the donor tissue. While this tool makes the process of separating the donor tissue into grafts quicker and easier, multi bladed knives have long since been discontinued by leading hair transplant clinics in order to minimize the transection and loss of a patients precious limited donor tissue. Leading clinic prefer to remove the donor strip using a single blade, while carefully controlling the angle and depth of the incision to minimize transecting (severing) the follicles along the cutting edge. The strip is then carefully slivered (sectioned) into smaller narrow strips under the microscopes to avoid transection. Thus while a patient may get impressive results from a surgery done using multi bladed removal, they will not know how many of their limited donor follicles were sacrificed during the surgery. I will not recommend a physician on this site who continues to use a multi bladed knife. The only physician in New England that I have the confidence in recommending is Dr. Ivan Cohen in Connecticut. To see highlights from my visit to his clinic, click here. P.S. In my opinion, Dr. Bob Leonard in New England appears to still be performing mini/micro grafting.

I'd like to thank members of this forum for their input as well as the current physician members of the Coalition of Independent Hair Restoration Physicians who provided me with their opinions privately. Based on Dr. Vogel's results, reputation and the feedback of his patients and colleagues I pleased to announce that he is our newest member of the Coalition. Best regards, Pat P.S. Joe, I did get to see two of Dr. Vogel's patients while I was at his clinic and their results were very natural.

Bill, I our forum software will implement such an auto resize feature I agree that this would be the ideal solution. Please keep posting this issue on their forum in public view so the ultimately have to address it. We like public accountability, right?

Bill, Thanks for staying on them. Perhaps we may need to set a limit to the file size of uploads at around 500k. I think posters should also try to limit the amount of posts in any one album to 15. Please also try to get them to add the ability for posters to embed hot links to text within photo albums. Thanks for your work on on this. Remember the "squeaky wheel gets the oil" especially on forums :-)

I would like to present Dr. James Vogel to the members of this community for consideration for membership in the Coalition of Independent Hair Restoration Physicians . As long time members of this community know, Dr. Vogel has had an excellent reputation for repairing previous hair transplant results and a track record of satisfied patients. A search using this forum's "Find" feature for "Vogel" will find many of his patient comments going back over five years. But not all members are aware that he and his experienced staff have also mastered follicular unit grafting and taken it to the ultra refined level. I visited Dr. Vogel's clinic this summer to observe his surgery and consider him for membership in the Coalition of Independent Hair Restoration Physicians. See the highlights from my visit to his clinic . Dr. Vogel also recently sent me photo examples of his results which are available for viewing on the photo album " Ultra Refined Results from Dr. James Vogel" To learn more about Dr. Vogel and view his current recommendation/profile and see addition before and after click here. Based on his strong credentials and reputation, experience and highly refined technique and results I think he has earned his place amongst the carefully chosen elite physician members of the Coalition. I welcome any comments or input regarding his proposed membership.

I would like to present Dr. James Vogel to the members of this community for consideration for membership in the Coalition of Independent Hair Restoration Physicians . As long time members of this community know, Dr. Vogel has had an excellent reputation for repairing previous hair transplant results and a track record of satisfied patients. A search using this forum's "Find" feature for "Vogel" will find many of his patient comments going back over five years. But not all members are aware that he and his experienced staff have also mastered follicular unit grafting and taken it to the ultra refined level. I visited Dr. Vogel's clinic this summer to observe his surgery and consider him for membership in the Coalition of Independent Hair Restoration Physicians. See the highlights from my visit to his clinic . Dr. Vogel also recently sent me photo examples of his results which are available for viewing on the photo album " Ultra Refined Results from Dr. James Vogel" To learn more about Dr. Vogel and view his current recommendation/profile and see addition before and after click here. Based on his strong credentials and reputation, experience and highly refined technique and results I think he has earned his place amongst the carefully chosen elite physician members of the Coalition. I welcome any comments or input regarding his proposed membership.

Bill, Thanks for recognizing some of our most active members for the many contributions they make. Mrjb, now that you are into the stratosphere of the follicular salvation club you are on such a high plane that daily life activities like eating and sleeping will diminish in importance. Thus you will find that you no longer need to have a normal "life". Just ask Nervous Nelly, who I believe gave up normal terrestrial life months ago. Of course you have a way to go before you walk on water and accend into the celestial heavens with you know who - no not the guy in sandals - Bill. Onwards and Upwards, Pat

Having attended the annual International Society of Hair Restoration Surgery (ISHRS) meetings over the past ten years, while publishing the Hair Transplant Network , I now seem to know or be known by almost all of the prominent hair transplant physicians. Those who have become famous online for doing outstanding work typically greet me warmly, while others who I have chosen not to recommend often stiffen up and scowl when they encounter me. One physician last week even took me aside in the hallway and threatened to sue me for having his recommendation discontinued. But, like it or not, most physicians have come to realize that our patient based community and our open forum are here to stay and that we will continue to say when the "emperor has no clothing" even if it may be awkward or embarrassing. As the publisher of this community, I will continue to critique various techniques, treatments and those who perform them, while keeping an eye out for top-notch physicians and clinics. I know the active members of this community will also continue to do the same. In this report I'd like to share highlights from the 15th annual ISHRS scientific meeting that was held in Las Vegas from September 26th to the 30th. I will focus on what may be of most interest to hair loss sufferers and patients such as presentations on the potential dangers of Dutasteride (Avodart), new advances such as hair multiplication (follicular cell implantation), the effectiveness of low light laser therapy (LLLT) in treating hair loss, the pros and cons of FUE (follicular unit extraction) and other topics. I've always been impressed by the attention to detail at these meetings, which truly give meaning to the expression "splitting hairs". Background on the meeting host - ISHRS The principal mission of the ISHRS (International Society of Hair Restoration Surgery) has been the education of hair restoration physicians ranging from the novice to the masters. It is by far the prominent hair restoration professional organization in the world and the host of the annual five day scientific meeting. The group's website at www.ISHRS.org provides contact information and profiles for its 700 worldwide physician members as well as useful information about hair restoration. This year Coalition member Dr. Sharon Keene of Tucson, Arizona did the hard work of chairing the meeting, while Coalition members Dr. Ron Shapiro of Minneapolis and Dr. Arthur Tykocinski of Sao Paulo, Brazil chaired the advanced seminar. Coalition member, Dr. Bill Reed of La Jolla, Ca was the chair for workshop chair. Last year's ISHRS meeting was chaired by Coalition member Dr. Bernie Nusbaum of Miami and next years ISHRS meeting in Montreal, Quebec will be chaired Coalition member Dr. Arthur Tykocinski. At the meeting Dr. Bessam Farjo of the UK replaced Dr. Paul Cotterill as the acting president of the ISHRS for the coming year. Many of the physicians who have come to be recognized by patients online for their outstanding results have also become known and recognized by their colleagues as leaders and teachers. Presentations at the ISHRS meeting of particular interest to Hair Loss Sufferers: Dutasteride (Advodart) versus Finasteride (Propecia) Virtually anyone who has researched hair loss treatments is familiar with Propecia (active ingredient Finasteride). This once a day pill, which inhibits the formation of the hair loss catalyst DHT in the body and thus scalp, is FDA approved as a hair loss treatment and widely known to be effective. However, some hair loss sufferers have sought and gotten prescriptions for an even stronger DHT inhibiting drug known as Dutasteride (marketed as Avodart). This drug, like Finasteride, is FDA approved for the treatment of benign prostatic hypertrophy (enlarged prostrate). However, Dutasteride (Avodart), unlike Propecia (Finasteride), has not been FDA approved as a hair loss treatment. Despite not being FDA approved as a hair loss treatment some physicians do prescribe it as a hair loss treatment, often only if Propecia fails to stop hair loss for a particular patient. Both finasteride and dutasteride inhibit the development of the type 2 alpha reductase that plays a critical role in the creation of the hair loss causing hormone DHT, only dutasteride also effectively inhibits the development of the type 1 alpha reductase that also plays a role in creating DHT. According to Dr. Bernie Nusbaum, who presented an update on Dutasteride therapy at the meeting, dutasteride is three times more potent than finateride at inhibiting the type 2 enzyme and 300 times more potent than finasteride in inhibiting the type 1 enzyme. Based on a randomized, placebo controlled study of 416 male hair loss sufferers, dutasteride improved hair growth in these men more rapidly and to a greater degree than finasteride. However, dutasteride was shown to remain in the body far longer than finasteride after being discontinued. Dutasteride was also found to reduce sperm counts more dramatically than finasteride along with a higher incidence of decreased libido (13%). Of additional concern, dutasteride, unlike finasteride, reduces the type 1 enzyme which is found in the brain ??“ unlike the type 2 enzyme which is not present in the brain. Apparently it is not clear at this time what role the type 1 enzyme may or may not play in the functioning of the brain. Thus dutasteride could potentially have yet unknown side effects due to reducing the type 2 enzyme in the brain. Advances in Medical Therapy and Hair Multiplication While scientific presentations on the theoretical causes and potential treatments of hair loss were made by expert hair scientists, no new break throughs or advances were presented at the meeting. However, it does appear that scientists are gaining a better theoretical understanding of the process of hair loss that may some day lead to more successful interventions and treatments. The current front runners in developing potential hair multiplication treatments are Intercytex and Aderans (the Japanese parent company/owner of the Bosely Medical Group and more recently Medical Hair Restoration). Both groups, despite continued research, investment and testing, have yet to prove that their current process of multiplying and then injecting a patient's own dermal papilla cells can yield viable new hair growth. I had the opportunity to visit Intercytex when I was in the UK during May of 2007 and meet with their founder Dr. Paul Kemp. I was impressed by the company's investment in time and resources to make hair multiplication a reality. The backgrounds and research credentials of the company's management team are also impressive. However, despite their persistent efforts and investment it appears to me that commercially viable follicular cell implantation ( often incorrectly referred to as hair cloning ) is at least five to ten years in the future. In addition, even if new hair follicles can be grown it still remains to be seen if the direction and angle of this hair growth can be controlled and if the hair quality will be adequate. Some feel that the replicated hair may be used, at least early on, primarily in the midscalp areas, while current hair transplant techniques using limited donor follicles will be used to recreate the hairline and other critical areas. The costs associated with such a procedure also remain unknown and even the principals at Intercytex could not venture a guess. In the event that follicular cell implantation becomes commercially viable it has the potential promise of enabling hair transplant patients to restore a virtually unlimited amount new hair growth. Needless to say this is a very exciting prospect, especially to who suffer from extensive hair loss and limited or compromised donor hair follicles. FUE (follicular unit extraction): Potential Pitfalls, Problems and Remedies Dr. James Harris, who has developed and widely shared his three step "SAFE" technique for FUE, gave an interesting and refreshingly candid presentation on the many difficulties and challenges physicians face in performing FUE successfully. Dr. Harris has recently patented a surgical methodology and instrumentation for performing FUE that in his opinion ensures graft safety and integrity. He calls it the "SAFE System" (Surgically Advanced Follicular Extraction) and the instrument is the "SAFE Scribe". Given that the vast majority of the information presented about FUE has been presented by those aggressively promoting it, very little of the technical challenges and problems are known among the general public. During Dr. Harris' talk, which was entitled "FUE: Potential Pitfalls, Problems and Remedies", he pointed out some of the following FUE pitfalls: Due to the traumatic cutting and pulling associated with the typical FUE extraction process, the underlying and largely unseen follicles are often transected and or damaged. The splaying (flaring outward) of the base of the follicles makes it particularly hard to cut around the underlying follicles with a punch. In addition, the grafts produced by FUE are typically almost devoid of protective dermis and fat and are therefore particularly vulnerable to damage and ultimately poor growth. This increased fragileness and damage of follicles is in part due to the supporting tissues and epithelium often being torn away during the pulling extraction process. When one is aware of the many risks and disadvantages associated with the FUE procedure one will not be surprised at the notable lack impressive final result photos available online. Those who have followed FUE over the years will notice the many immediate post op FUE photos are often provided by the promoters of the high priced FUE procedure, while follow up photos and final results have been notoriously absent. However, in recent years ethical and skilled physicians and clinics, who do not oversell the benefits of FUE, have begun to advance this procedure. It is possible that many of the pitfalls of FUE will be overcome and that these physicians and their patients will present impressive results both on and offline. Dr. Paul Rose and DR. Jose Lorenzo also both presented impressive tools and techniques at the meeting for overcoming some of the issues and pitfalls associated with FUE. Low Level Laser Therapy (LLLT) in Hair Restoration Hair loss sufferers continue to debate and question the value of Low Level Laser Therapy (LLLT) for hair loss on this forum and others. Hair restoration physicians also continue to question its value, while some physicians who have been using it in their practices swear by LLLT and claim that it can improve post surgical healing, accelerate growth, stimulate increased hair diameter and even new hair growth comparable to 5% minoxidil. Some physicians believe so strongly in the healing properties of LLLT that they provide it free of charge to patients in the weeks following their surgery. They and their staffs are confident that LLLT does at least provide a marginal if not more significant benefit in speeding post op healing and new hair growth. Some physicians believe that LLLT combined with 5% minoxidil can provide synergistic benefits (i.e. 2 + 2 = 7) that neither treatment alone can accomplish. They believe that such a combined treatment is particularly beneficial to women with diffuse patterns of hair loss who have no other treatment options. One study presented at the ISHRS meeting by Maria A Muricy, MD, provided some statistically significant evidence that LLLT combined with 5% minoxidil did provide noticeable cosmetic benefits for women in particular. However, this study also showed that LLLT alone produced no statistically significant new hair growth in both men and women. But while it showed no new hair growth, the researchers found that LLLT alone may increase the diameter and quality of existing hairs and thus improve the overall appearance of fullness. I had an interesting conversation with Charles Maricle, Ph.D., who is a leading expert on medical low light lasers and the President of Sunetics International (which manufactures and markets LLLT devices to hair restoration clinics). As one would expect, he is confident in his products ability to aid in post op recovery and regrowth, as well as helping others regrow hair. The next time there is an active discussion on our forum about LLLT I intend to invite him to add his expertise to the discussion. LLLT ??“ FDA Approved? Dr. Alan Bauman gave a brief presentation on the FDA clearance of LLLT devices produced by Lexington International (makers and marketers of the Laser Hair Comb) for use as hair loss treatments. While these LLLT devices were found by the FDA to be safe based on its "substantial equivalence" to previously approved LLLT devices and thus "cleared" (not "approved"), it was not clear to me to what extend the FDA reviewed or cleared the LLLT based on its effectiveness in treating hair loss. Apparently the FDA did require Lexington to provide it with a study on the efficacy (effectiveness) of LLLT in treating hair loss. But this study and its results, which was apparently funded by Lexington International, has not been released publicly to my knowledge as Lexington International had the option of submitting it to the FDA, while keeping the study private. To learn more about the FDA standards for "approving" food and drugs and for "clearing" medical devices visit www.fda.gov The obvious question then is ??“ why would Lexington not make their study public if it indeed did prove that their LLLT products were effective in treating hair loss? It appears to me that the LLLT industry is now promoting their devices as "FDA Approved for Hair Loss" as if they are on pare with the two only other FDA hair loss treatments "Propecia" (finasteride) and "Rogaine" (Minoxidil). At this point, until LLLT provides compelling public evidence of LLLT effectiveness in treating hair loss, in my opinion the effectiveness of LLLT may potentially be oversold. I expect that "time will tell".

Having attended the annual International Society of Hair Restoration Surgery (ISHRS) meetings over the past ten years, while publishing the Hair Transplant Network , I now seem to know or be known by almost all of the prominent hair transplant physicians. Those who have become famous online for doing outstanding work typically greet me warmly, while others who I have chosen not to recommend often stiffen up and scowl when they encounter me. One physician last week even took me aside in the hallway and threatened to sue me for having his recommendation discontinued. But, like it or not, most physicians have come to realize that our patient based community and our open forum are here to stay and that we will continue to say when the "emperor has no clothing" even if it may be awkward or embarrassing. As the publisher of this community, I will continue to critique various techniques, treatments and those who perform them, while keeping an eye out for top-notch physicians and clinics. I know the active members of this community will also continue to do the same. In this report I'd like to share highlights from the 15th annual ISHRS scientific meeting that was held in Las Vegas from September 26th to the 30th. I will focus on what may be of most interest to hair loss sufferers and patients such as presentations on the potential dangers of Dutasteride (Avodart), new advances such as hair multiplication (follicular cell implantation), the effectiveness of low light laser therapy (LLLT) in treating hair loss, the pros and cons of FUE (follicular unit extraction) and other topics. I've always been impressed by the attention to detail at these meetings, which truly give meaning to the expression "splitting hairs". Background on the meeting host - ISHRS The principal mission of the ISHRS (International Society of Hair Restoration Surgery) has been the education of hair restoration physicians ranging from the novice to the masters. It is by far the prominent hair restoration professional organization in the world and the host of the annual five day scientific meeting. The group's website at www.ISHRS.org provides contact information and profiles for its 700 worldwide physician members as well as useful information about hair restoration. This year Coalition member Dr. Sharon Keene of Tucson, Arizona did the hard work of chairing the meeting, while Coalition members Dr. Ron Shapiro of Minneapolis and Dr. Arthur Tykocinski of Sao Paulo, Brazil chaired the advanced seminar. Coalition member, Dr. Bill Reed of La Jolla, Ca was the chair for workshop chair. Last year's ISHRS meeting was chaired by Coalition member Dr. Bernie Nusbaum of Miami and next years ISHRS meeting in Montreal, Quebec will be chaired Coalition member Dr. Arthur Tykocinski. At the meeting Dr. Bessam Farjo of the UK replaced Dr. Paul Cotterill as the acting president of the ISHRS for the coming year. Many of the physicians who have come to be recognized by patients online for their outstanding results have also become known and recognized by their colleagues as leaders and teachers. Presentations at the ISHRS meeting of particular interest to Hair Loss Sufferers: Dutasteride (Advodart) versus Finasteride (Propecia) Virtually anyone who has researched hair loss treatments is familiar with Propecia (active ingredient Finasteride). This once a day pill, which inhibits the formation of the hair loss catalyst DHT in the body and thus scalp, is FDA approved as a hair loss treatment and widely known to be effective. However, some hair loss sufferers have sought and gotten prescriptions for an even stronger DHT inhibiting drug known as Dutasteride (marketed as Avodart). This drug, like Finasteride, is FDA approved for the treatment of benign prostatic hypertrophy (enlarged prostrate). However, Dutasteride (Avodart), unlike Propecia (Finasteride), has not been FDA approved as a hair loss treatment. Despite not being FDA approved as a hair loss treatment some physicians do prescribe it as a hair loss treatment, often only if Propecia fails to stop hair loss for a particular patient. Both finasteride and dutasteride inhibit the development of the type 2 alpha reductase that plays a critical role in the creation of the hair loss causing hormone DHT, only dutasteride also effectively inhibits the development of the type 1 alpha reductase that also plays a role in creating DHT. According to Dr. Bernie Nusbaum, who presented an update on Dutasteride therapy at the meeting, dutasteride is three times more potent than finateride at inhibiting the type 2 enzyme and 300 times more potent than finasteride in inhibiting the type 1 enzyme. Based on a randomized, placebo controlled study of 416 male hair loss sufferers, dutasteride improved hair growth in these men more rapidly and to a greater degree than finasteride. However, dutasteride was shown to remain in the body far longer than finasteride after being discontinued. Dutasteride was also found to reduce sperm counts more dramatically than finasteride along with a higher incidence of decreased libido (13%). Of additional concern, dutasteride, unlike finasteride, reduces the type 1 enzyme which is found in the brain ??“ unlike the type 2 enzyme which is not present in the brain. Apparently it is not clear at this time what role the type 1 enzyme may or may not play in the functioning of the brain. Thus dutasteride could potentially have yet unknown side effects due to reducing the type 2 enzyme in the brain. Advances in Medical Therapy and Hair Multiplication While scientific presentations on the theoretical causes and potential treatments of hair loss were made by expert hair scientists, no new break throughs or advances were presented at the meeting. However, it does appear that scientists are gaining a better theoretical understanding of the process of hair loss that may some day lead to more successful interventions and treatments. The current front runners in developing potential hair multiplication treatments are Intercytex and Aderans (the Japanese parent company/owner of the Bosely Medical Group and more recently Medical Hair Restoration). Both groups, despite continued research, investment and testing, have yet to prove that their current process of multiplying and then injecting a patient's own dermal papilla cells can yield viable new hair growth. I had the opportunity to visit Intercytex when I was in the UK during May of 2007 and meet with their founder Dr. Paul Kemp. I was impressed by the company's investment in time and resources to make hair multiplication a reality. The backgrounds and research credentials of the company's management team are also impressive. However, despite their persistent efforts and investment it appears to me that commercially viable follicular cell implantation ( often incorrectly referred to as hair cloning ) is at least five to ten years in the future. In addition, even if new hair follicles can be grown it still remains to be seen if the direction and angle of this hair growth can be controlled and if the hair quality will be adequate. Some feel that the replicated hair may be used, at least early on, primarily in the midscalp areas, while current hair transplant techniques using limited donor follicles will be used to recreate the hairline and other critical areas. The costs associated with such a procedure also remain unknown and even the principals at Intercytex could not venture a guess. In the event that follicular cell implantation becomes commercially viable it has the potential promise of enabling hair transplant patients to restore a virtually unlimited amount new hair growth. Needless to say this is a very exciting prospect, especially to who suffer from extensive hair loss and limited or compromised donor hair follicles. FUE (follicular unit extraction): Potential Pitfalls, Problems and Remedies Dr. James Harris, who has developed and widely shared his three step "SAFE" technique for FUE, gave an interesting and refreshingly candid presentation on the many difficulties and challenges physicians face in performing FUE successfully. Dr. Harris has recently patented a surgical methodology and instrumentation for performing FUE that in his opinion ensures graft safety and integrity. He calls it the "SAFE System" (Surgically Advanced Follicular Extraction) and the instrument is the "SAFE Scribe". Given that the vast majority of the information presented about FUE has been presented by those aggressively promoting it, very little of the technical challenges and problems are known among the general public. During Dr. Harris' talk, which was entitled "FUE: Potential Pitfalls, Problems and Remedies", he pointed out some of the following FUE pitfalls: Due to the traumatic cutting and pulling associated with the typical FUE extraction process, the underlying and largely unseen follicles are often transected and or damaged. The splaying (flaring outward) of the base of the follicles makes it particularly hard to cut around the underlying follicles with a punch. In addition, the grafts produced by FUE are typically almost devoid of protective dermis and fat and are therefore particularly vulnerable to damage and ultimately poor growth. This increased fragileness and damage of follicles is in part due to the supporting tissues and epithelium often being torn away during the pulling extraction process. When one is aware of the many risks and disadvantages associated with the FUE procedure one will not be surprised at the notable lack impressive final result photos available online. Those who have followed FUE over the years will notice the many immediate post op FUE photos are often provided by the promoters of the high priced FUE procedure, while follow up photos and final results have been notoriously absent. However, in recent years ethical and skilled physicians and clinics, who do not oversell the benefits of FUE, have begun to advance this procedure. It is possible that many of the pitfalls of FUE will be overcome and that these physicians and their patients will present impressive results both on and offline. Dr. Paul Rose and DR. Jose Lorenzo also both presented impressive tools and techniques at the meeting for overcoming some of the issues and pitfalls associated with FUE. Low Level Laser Therapy (LLLT) in Hair Restoration Hair loss sufferers continue to debate and question the value of Low Level Laser Therapy (LLLT) for hair loss on this forum and others. Hair restoration physicians also continue to question its value, while some physicians who have been using it in their practices swear by LLLT and claim that it can improve post surgical healing, accelerate growth, stimulate increased hair diameter and even new hair growth comparable to 5% minoxidil. Some physicians believe so strongly in the healing properties of LLLT that they provide it free of charge to patients in the weeks following their surgery. They and their staffs are confident that LLLT does at least provide a marginal if not more significant benefit in speeding post op healing and new hair growth. Some physicians believe that LLLT combined with 5% minoxidil can provide synergistic benefits (i.e. 2 + 2 = 7) that neither treatment alone can accomplish. They believe that such a combined treatment is particularly beneficial to women with diffuse patterns of hair loss who have no other treatment options. One study presented at the ISHRS meeting by Maria A Muricy, MD, provided some statistically significant evidence that LLLT combined with 5% minoxidil did provide noticeable cosmetic benefits for women in particular. However, this study also showed that LLLT alone produced no statistically significant new hair growth in both men and women. But while it showed no new hair growth, the researchers found that LLLT alone may increase the diameter and quality of existing hairs and thus improve the overall appearance of fullness. I had an interesting conversation with Charles Maricle, Ph.D., who is a leading expert on medical low light lasers and the President of Sunetics International (which manufactures and markets LLLT devices to hair restoration clinics). As one would expect, he is confident in his products ability to aid in post op recovery and regrowth, as well as helping others regrow hair. The next time there is an active discussion on our forum about LLLT I intend to invite him to add his expertise to the discussion. LLLT ??“ FDA Approved? Dr. Alan Bauman gave a brief presentation on the FDA clearance of LLLT devices produced by Lexington International (makers and marketers of the Laser Hair Comb) for use as hair loss treatments. While these LLLT devices were found by the FDA to be safe based on its "substantial equivalence" to previously approved LLLT devices and thus "cleared" (not "approved"), it was not clear to me to what extend the FDA reviewed or cleared the LLLT based on its effectiveness in treating hair loss. Apparently the FDA did require Lexington to provide it with a study on the efficacy (effectiveness) of LLLT in treating hair loss. But this study and its results, which was apparently funded by Lexington International, has not been released publicly to my knowledge as Lexington International had the option of submitting it to the FDA, while keeping the study private. To learn more about the FDA standards for "approving" food and drugs and for "clearing" medical devices visit www.fda.gov The obvious question then is ??“ why would Lexington not make their study public if it indeed did prove that their LLLT products were effective in treating hair loss? It appears to me that the LLLT industry is now promoting their devices as "FDA Approved for Hair Loss" as if they are on pare with the two only other FDA hair loss treatments "Propecia" (finasteride) and "Rogaine" (Minoxidil). At this point, until LLLT provides compelling public evidence of LLLT effectiveness in treating hair loss, in my opinion the effectiveness of LLLT may potentially be oversold. I expect that "time will tell".

Larry, Welcome to our forum community. I enjoyed "talking shop" with you a few days ago at the ISHRS meeting in Las Vegas. As you know, I've been a big sckeptic of FUE over the years for many reasons, including the big promises that have too often been followed by patient photos that show immediate post op results but very little follow up. Unfortunately, many of the physicians and clinics that were associated with FUE in the past had very low ethics and poor results at very expensive prices in my opinion. I hope that you and your group will present FUE - both its pros and cons - responsibly online and thus establish legitamacy for this procedure. I commend you for presenting long term follow up photos, which do show real improvement and good donor healing. Your use of the smaller 0.75 punch does also hold promise for truly minimizing cosmetically visible scarring in the donor area. Of course, successfully scoring and excising follicles with such a tiny punch with out transecting the follicles is very challenging. I look forward to you disclosing more about your process in time. Best wishes, Pat

Rahul, Thanks for this info and the clarification. I do agree that their reporting is very hard to understand. I find it vague. My sense is that since the company is still raising funds they are putting the best face possible on their current results. But 100% or 200% increases on next to nothing don't amount to much. Thanks again, Pat