gillenator

PC, I agree with you that meeting with a consultant first is okay for the purpose of answering "general" questions the patient has. But it is absolutely imperative that every patient have their medical history cleared by the doctor and also have their donor areas examined and calculated for density, discussion of life-long goal planning, use of medications and scripting of such, etc, etc. Of course there are times an out-of-area patient may have to do a virtual consultation, but still an exam "prior" to surgery is critical. There are some areas of evaluation that only the licensed physician can discuss with the patient as reps cannot practice medicine. So I agree, there's certainly nothing wrong with talking to a rep first, but from a legal standpoint, a rep cannot disqualify a patient for "any" surgical procedure, although it is common place with some clinics, especially the mills.

Hi Bonzo, Hope you have been finding this forum helpful and it sure sounds like you had a good constructive consultation. CONGRATS!, you had the chance to meet the doctor! Dr. Keene I think once worked for MHR for a very short time and left. I will stand to be corrected on that if necessary. I have seen and heard good things in her work. She is truly a professional and have heard nothing but good things about her. I have referred other patients to her in the Southwest. I wanted to ask you if your plugs are growing well and not pitted, cratered, cobblestone effect, etc. Do you have a wide or narrow hair-to-scalp color contrast? Although plugs do not have the aesthetic appeal, I have seen a fair amount of open-donor work over the years and some that are growing very well, without the afore-mentioned ill-effects to the scalp tissue. Skilled surgeons in FUE can sometimes "thin" the plugs out by extracting the FU's within the plugs and then re-implant those extractions in the recipient area. In a nutshell, it can potentially thin the density of the plug and increase the aesthetic result by distributing the extracted grafts. Then of course you have the additional 1500-2000 grafts left in the donor area to add to it. There are of course situations where it may be best to leave the plugs the way they are and fill in around them so possibly this is your situation. Don't get me wrong, it's not that I disagree with Dr. Keene's assessment, but if you do have a wider color contrast, and the plugs seem to stand out like a sore thumb, you may want to talk to a couple of FUE surgeons who "specialize" in repair work for the added opinions. Just a thought. And then there are situations where the plugs are surgically removed which is typically the plastic surgeons' approach, they are then dissected into seperate FUs and re-implanted. Most patients do not like this approach and also is done when the plugs are in bad shape. Once the plug is removed, the opening is closed with a single suture. My encouragement to you is to become familiar with "all' of your options if you have not done so already and let us know how things go. Best wishes to you!

Take Arfy's post to heart on this one. The only thing I would like to add is that consider e-mailing your pics and background to the docs you have researched that are out of your area before you jump on a plane or drive cross-country. You will be amazed by some of the results. It will provide you a preliminary impression of that clinic "and" doctor. Be patient, because good HT surgeons spend alot of time in the OR and it may take a little while to hear back. Then after you get their initial responses back, not a consultant or sales person, but the doctor himself, consider who you think has your best interest at heart, in both results and patient care. If anything, it will probably help you to narrow your search before you get on an airplane. Best wishes in your search. Tman, I saw that drummer of the Doobies on an informercial before and I could have sworn it was for Bosley. Maybe he is in both endorsements!

Chris2b, I wonder if Dr. Diodocha was in surgery at the time of your consultation. Meeting with the surgeon is the most important part of the consultation for the obvious reasons. It also provides the doctor the opportunity to review the patient's medical history. Hopefully you will get a chance to hear his opinion as I have heard some good things about him. I know I also suggested Dr. Harris who as previously mentioned is doing FUE and developed some of his own instrumentation. Other surgeons including some of those who attended the last ISHRS conference speak highly of his work and respect him as a colleague. I am clearly not a proponent of the hair mills for the reasons that I have stated on other threads. Either way, you are the patient, and so decide on whomever you think will provide you the best result, has good ethics, and will give you the opportunity to meet with him/her pre-operatively speaking. Sometimes patients have to e-mail pics because the doctor of their choice is not in their immediate area. But it sounds like the docs you are considering are within your driving range and if so, I would insist on a comprehensive physical evaluation by the surgeon. Best wishes to you and hope things work out well.

Gavin, Well how are things in Ireland? Being half Irish, I have always wanted to visit the country but to date have not made it as I am restricted from being in high altitudes like airplanes. A couple of things you should know. The effective inhibition period for Propecia (finasteride) is approximately 90 days. In other words it takes roughly three months from ingestion for finasteride to begin "effectively" functioning as a hormone inhibitor. Its pharmacology classification is a "specific hormone inhibitor". So getting back on it will take a little time to see its effects and also do not be alarmed if you shed some more because you do have some follicules that will enter the shedding (catagen) phase. Also be advised that both finasteride and minoxidil do not claim any effeciency in the frontal zone, only the mid (vertex) and post (crown) areas. The disclosures and clinical trials for both Propecia and Rogaine clearly disclose this in their packaging. Do not expect finasteride or minoxidil to save your hairline. I believe you would have sustained hairloss in the front even if you had remained on finasteride. Hairloss is very progressive and unfortunately, a life-long event. When I used to be a consultant I would sometimes hear other consultants state to patients that if they started Propecia and then got a HT, they would be set for life, no more hairloss. This simply is not true. Genetic hairloss can be VERY unpredictable EVEN when on hairloss meds. I have heard from guys who have been on finasteride for 3,5 years or so and all of a sudden BANG, it begins again. That's why it is SO important when examined by any HT surgeon to know the zones of demarkation (areas of miniturization) affecting your scalp bacause that is the indication of where future loss will probably manifest. And it's those areas that you will want to consider for future restoration. If your family history displays advanced hairloss classes for the men in your genetic background, all the more reason why one should have plans for addressing future loss and restoration. I always caution men who desire complete coverage and yet visually show the potential of being in a Norwood 6 and 7 in the future. I "always" ask them, what happens if you lose more hair when you get older and you run out of donor? Some will say, "if I cannot get complete coverage (illusion of coverage), I don't want to even start". And I agree for those who will not want anything short of it. Since you are beginning to experience loss in the frontal zone, just be sure that you know your donor limitations so you can plan accordingly. Some guys do not care about crown coverage and have plenty of donor for the front and mid-range, but only you can decide for yourself. Not everyone's goals are the same. Best wishes to you!

Hi DanielTaylor2, The only thing about cutting the small tablet "free-hand" is the risk of cutting yourself with the blade. Alot of pharmacies sell the pill cutters and you do want one that has the "v" guide that the pill slides in to. That's the type I use and I have been cuting Proscar for many years now. Actually with practice you will find it easier and before you know it, you will master it. It's true that finasteride has a long shelf-life so the minor irregularities in the pieces won't matter, and if one of the pieces come out bigger, skip a day. You can also put a note or checkmark on your calendar as to which days you are skipping, so it does not get confusing. Best wishes to you.

Any male 40 years of age or older considering starting finasteride for treating genetic hairloss should have a PSA test done prior to ingestion. Further, any males that are using finasteride in a different form other than Propecia, should make sure the prescribing physician charts the fact that the medication is for treating hairloss. Lots of guys are quartering Proscar to save money but many PCPs and even Dermatologists are unaware that this economical approach is being used by patients.

Hi chris2b, Welcome to this forum! You may also want to consider Dr. James Harris who is an MD and part of this network. Just go to the home page and click on the state of Colorado and I believe he practices out of Englewood. He also does FUE, and developed instrumentation for it. Best wishes to you on your search.

Hi Patti, Hey, welcome to this forum! Just wanted to encourage you to have "complete" blood work done if you have not already done so. There are many more potential causes of hairloss in women than men, generally speaking, and you want to be sure that your hairloss is in fact genetic. Sometimes thyroid problems, hormonal changes etc, can be treated medicinally with a chance of your hair growing back. My point is, know exactly what you are dealing with before you invest your hard earned money into other cosmetic approaches. Best wishes to you!

Hi mss28, What FS stated is very true. I just spoke with one of Dr. Rose's patients yesterday and he had his third procedure which he thinks will be his last one. He looks awesome! He used to surf these forums quite a bit when he was going through his research stage. I asked if he was still active on the forums and he advised me that he no longer had any need to. So I too see lots of folks move on with their lives unlike some of us hair junkies! Anyway, my first transplant was in 1996 (nine years ago) and is still growing! Had my second HT in 2001 and the last one in 2002. All still growing! I mentioned in another thread that I still see patients who had open donor 25 years ago or so and the plugs are still growing in most cases. Although there is no aesthetic appeal, the hair is growing!

Hi TM, You look like a completely different person now! The pics on your other post were very good in displaying total views, even from the top. I noticed your surgeon placed more grafts in the front forelock area and coronet area of crown. Are you very tall? If so the mid-range or bridge area does not typically need as many grafts since that area is not well seen by others. I saw the singles in the hairline just above the frontallis area so I think the placement looks very natural and compliments your face symmetrically speaking. Your more narrow color contrast is also helping. Another pass would be awesome for density if that's what you want. You must be getting alot of compliments! Are you planning on posting some pics at 12-14 months? Take care!

Hi Hairbank, Thanks for the additional info and I agree totally with you that placement is a very important issue. Now there are a couple of things to consider. First, find out your total potential grafts from the donor areas. Harryone made some interesting points to consider especially regarding coverage for those of us in the more advanced Norwood classes. Once you have a better idea of how much your donor will produce, you can better analyze where you want coverage in a lifetime. As grafts are added and then fully mature you will see the result and then again make decisions on where you want additional hair in future procedures. Most of us will inform you that there is more of a clinical advantage in doing a larger session to start with, but if you have budgeting concerns, you can still start with 1200 grafts. Your question however is where to place them right? That gets back to your goals for Hairbank and only Hairbank. You are now 38 so I would presume you are not trying to acheive youthful density. In addition you mentioned you are considering 80% in the front and 20% in the back. Since the real impact of our appearance is viewed from the front, you are definitely on the right track. In fact after the first procedure grows out, you may elect to have even more grafts placed in the front to mid-scalp range to get the most aesthetic benefit possible. Now I have not forgot about your crown area but again by your comments, it appears that the front is ranking higher in your decision of coverage. Since you prefer not to use finasteride, minoxidil, etc., the crown will undoubtedly lose more natural hair or at least plan on that happening. The circumference of that area can potentially demand as much as 50% of one's available donor (excluding body hair). That does not leave that much for the frontal and mid-range areas. You can always add a single pass through the crown area later by visually reducing the thinnig area, but it will not acheive full coverage unless you later add body hair in that area. Now let's discuss potential shockloss. You have diffused thinning throughout the top of your scalp. One of the potential dis-advantages of doing mega-sessions is the probability of shockloss to the natural hair that is up there right now in the recipient areas. Since you are not taking finasteride or using minoxidil, the level of shockloss could be higher than expected and the natural hair may or may not grow back. The finer diffused hair that now looks like peachfuzz will not come back. Shockloss is unpredictable so patients with a diffused thinning pattern need to consider how large of a session they want to start with. Remember, hair caliper (coarseness) is the single most important factor in gaining the "illusion" of coverage. The fatter the hair cylinders, the better coverage obtained. If you have not already, take a look at Ramo's pics. He just had I believe a 1300 graft procedure 7 months ago with most of the grafts in the frontal zone. Take note that he has a natural wave characteristic to his hair. His newly grown in hair in the hairline and front forelock area displays alot of volume or body for 1300 grafts, so the wave provides him additional benefit. Both of you have a wider color contrast but also notice the visual benefit he received as he is viewed from the front. I wish you the very best in your planning and results!

Robert, Just saw your six month pics. WOW! Incredible! I know you have mentioned that using MSM has helped to put the medal to the pedal regarding growth and it obviously has helped quite a bit. With 2300 grafts and at six months, just wait until you hit that one year mark. If the girls are after your ball cap now, just wait till everything fully matures! They'll be chasing more than that! How about a six month pic view from the front looking straight on. My bet is that you look younger. Happy growth!

Damo, You should be at about 7 months post-op now right? The work looks nice especially the hairline on the most recent 6 month pics. The front forelock also looks like it is blending in quite well. I compared the pic of the frontal recipient area just after surgery to the last front view pic and I can definitely see the hairline and temporal lobe areas growing in from where the recipient sites were made. It looks like the hairline over your left eye has some growth yet to come so don't worry, you still have some coming. Your frontal view looks great man!

Hi Hairbank, Thanks for posting your pics! How many grafts are you planning on and what recipient areas are they going in? Are you are on Propecia (finasteride) or minoxidil? How many potential harvestable grafts do you have in the donor areas? What are your goals in the first session? How old are you and to what extent is genetic hairloss in your family history? Any men in the Norwood 7 class like grandfathers, uncles, father, brothers, etc? I do not mean to present so many questions at one time but more info would be helpful to give you some concrete feedback.

A urine analysis profile is generally not required in the pre-lab work for a HT procedure, in fact I have never seen it requested by any medical staff for HTs. The screening for HIV and all panels of Hep are usually done as was mentioned. Any prudent Physician will cover your entire medical history with you once the patient has provided all of the information. Most doctors and clinics will ask you to complete their forms once you arrive for your appointment. Then the doctor will review all past and current medical conditions/issues including medications. For example, if a potential HT patient was currently on blood thinners, certain beta blockers, etc the HT doctor may need to concur with the patient's PCP/specialist for medical release. If it is determined that the patient has an intervening condition that might affect the candadicy or the successful outcome of the procedure, it should be brought out upfront and discussed in the consultation. The alchohol and controlled-substance use is and or should be part of the confidential questionaire in the initial paperwork completed. The issue is frequency of use and of course the ceasing of this activity pre-operatively speaking. So any responsible clinic will ask the patient to cease alchohol and marijuana for at least one week prior to the procedure. That goes for tobacco as well. Excessive bleeding and issues of healing are the concerns.

Hi Tomy51, Did the Bosley sales rep scientifically calculate your donor density or did the rep make an assumption based on a visual observation? Very few sales reps have any clinical training, neither are they allowed to practice medicine. Was there a Bosley doctor present that physically examined your donor areas, took precise hair count within several defined areas, measured your recipient areas, etc? Then were your density levels documented in a chart along with the other pertinent notes? If not, then you can be assured that you were provided a guess or a simple estimate of what that person thought. It appears that you have not had a HT procedure before but certainly feel free to correct me if I am wrong. The graft ranges you were given sound very low for a virgin donor area. The average patient has much higher donor levels to where ultimately 5,000 to 6500 grafts could be safely harvested in the hands of a skilled proven HT surgeon. So you really owe it to yourself to get another opinion based on an actual clinical approach as I outlined above. Then and only then will you have an "accurate" idea of your total potential for hair restoration. Once you have all of the facts, based on your own personal profile, I truly hope you will be able to acheive the realistic goals you have in mind. Best wishes to you Tomy51!

I agree and Merck also states that it makes no difference, night or day. No need to ingest it with food either although I always consume something before I take any med. As good ole Kez stated the key is to take it every day for optimal efficiency. Since Propecia's release I have found that men would unintentionally forget to take it. So I have always advocated to take it when you do something else that is part of one's daily routine. Brushing your teeth in the morning, at dinner-time, etc. The good thing is that you are taking it!

Thanks HBT. It's good to be back and yeah am now fully recovered so thanks for the concern brother. Have one more surgery in Febuary but that should be a cake walk compared to that awful kidney stone! WHEW! The stone was sent off to the lab for analysis.

Marcelo, Well I am certainly glad to hear it has slowed down and my guess is that you are about done now. Just think though, the best part is yet to come! THE NEW GROWTH!!! FYI, the shock loss is evidence that these follicules are now in telogen (resting) and then they move into the anagen (growth) phase. Do not be skeptical if it takes several months for the new hair to emerge. Hopefully the shockloss has not made a pronounced difference in your visual coverage. I know myself and others here have used products like Toppik until the procedure fully matures. Best wishes to you.

Marcelo, The average would be about 2-4 weeks, that's the intial fall-out from trauma to the scalp. There are always exceptions. How long ago did you have your procedure?

I do believe that 90% of men are negatively affected by their genetic hairloss. But when you consider the aggregate annual number of HT procedures done in the US alone, it is a mere percentage of the millions of men suffering from MPB. I am not sure if those stats quoted are very accurate and possibly they are a compiliation of the "plastic surgeons" that do HTs, not necessarily including derms and other MDs, DOs, etc. The other thing about cloning or scalp impregnation is that once the cells are injected into the scalp and they estabilsh hair follicules, will they be situated in the proper position to grow the new hair at the appropriate angles? I mean if it becomes proven and viable for success in humans, how will the aesthectic effect come out? Will there be a fair distribution of density? Food for thought.

Arfy, I recently heard a little while back that Dr. Puig is now MHR's Medical Director. Do you know if that's official? If so I wonder what implications that may have on their organization and future patients. I just saw a commercial of theirs although I have not noticed as many infomercials. But then again I am not up at 2,3,4 in the morning to notice.

I have observed the same thing as Arfy noted on older men. That is a general thinning "throughout" the entire scalp. My own father (75 years old) has this type of thinning yet he never had androgenetic alopecia (MPB) in his entire life. He always had a very thick head of hair until his mid sixties or so. My own clinical opinion is that the hair follicules remain in telogen (rest phase) for longer periods and anagen (growth phase) for shorter periods as men reach retirement or senior ages. My father does not have any isolated areas of thinning like the crown or temporal lobe areas, just general thinning everywhere. My first FU procedure was done in 1996 which was 9 years ago and still with me. My second procedure was done in 2001 and that terminal hair is still with me. The third transplant was done in 2002. So I am very thankful that I still have my transplanted hair! I have seen many patients who had open donor (plugs) procedures done 20 -25 years ago and those plugs are still growing. So my conclusion is that there is definitely a genetic predisposition that affects us all differently regarding MPB. I only know of a few cases where the older patient lost terminal hair that was transplanted or considerable hairloss in the donor (permanent) zones. But the loss in the donor areas was unrelated to MPB. And I do agree with Arfy that hairloss is progressive, that is, once MPB starts it does not resolve itself on its own. I have seen other men and women not show evidence of MPB until 50 years of age, although that is the exception, not the rule. The meds will buy us time but they will not cure MPB. So we can try to save the natural hair affected by DHT with meds and use transplanted terminal hair from the donor zones to fill in what is missing to try and create the most aesthetically pleasing appearance that we can within our own limitations. And hopefully this will enhance our quality of life for many years to come! Best wishes to all.

Smoothy, Thanks for the comment. Yes Dr. Rose is a very genuine individual and does great work. He will be doing my next procedure when I am ready financially speaking. Hairbegood, Depending if you have strip or FIT, you will find Dr. Rose very competitive in contrast to other good surgeons and his colleagues. You can e-mail him at paultrose@yahoo.com for a personal evaluation on your needs, graft count, etc. Arfy, Dr. Rose has been a long-time member of this network and coalition. Pat and I have been discussing Dr. Rose's work and we almost did our procedures togethor. Surely you have heard about him over the past 15 years or so? I know you go back a ways in this field as I do and I thought maybe you have heard about his astute repair work before.