Ailene

Joe, We also had a problem with a doc using our photo's. A doc in Texas used photo's downloaded from a brouchure. When we contacted him it was a similar response, "what differece does it make, we all do the same work". My response was "It is not your work and you are taking credit for something you did not do". He hung up on me and it took us an attorney and 6 months for him to remove it. My other question to him was if he had been doing transplants "for years", where were his before and after photo's...... He did not appreciate my humor.... Ailene

I tell all our patients that many things really depend on what they hope to accomplish. You did not give a lot of back round information. It appears your donor hair is of good quality but it is hard to judge from photo's what the density actually is. Laxity of the scalp is also a part of the puzzle. Are you on medications to inhibit future loss? A transplant simply moves hair not genetically programmed to be succeptable to the DHT that causes male pattent balding. The numbers recommended would give good coverage to the front but it may create a "fluffy" look if you cover from front to back. The biggest concideration for transplantation into the crown is future loss. The pattern in the back if it continues can create a halo or island iffect. This would be unnatural and may require future treatment. Frontal restoration using good technique can create a long lasting natural hairline. It is all basically math. The square cm vs the area to be covered and factor in the existing hair. If the frontal hairline and top are the target the number of grafts would be a huge improvement using good technique. Covering front to back it will be a little diffuse. Ailene

You can count Dr. Cooley, Brandi and me on the guest list! I do not think we have missed an invitation from Pat in all these years. We look forward to it. Please send me the details. See you in Montreal! Ailene

At Carolina Dermatology Haircenter our clinic is a little different than many other clinics. I am not a "consultant". We do not have a consultant. I understand this limits the availability I have to the phone or even emails but when I do discuss a patients situation with them they have my total attention. I am the clinical supervisor for the entire clinic. My role in the consultation is to educate the patient. I have worked in surgery with Dr. Cooley since 2000. Many times a patient will tell me they have done their due dilligence but until I discuss all of the issues Dr. Cooley feels are important in making the decision to move forward with a transplant. Part of this is to discuss Dr. Cooley's qualifications. I also tell any patient who enquires that there are other doctors who we all admire and who do excellant work. Many of them Dr. Cooley feels were his mentors and many of them I have personally observed or had the honor of assisting in a live surgery. I do tell all my patients that research is their best friend and if asked I will tell them how we stand apart from many. We are very open about our approach to surgery and we care about the education of the patient and their decision. We do not subscribe to a "sales approach" but truly want this decision to be one that is a good investment. We feel so honored by all the patients who post their results and the positive feedback we receive from their experiences with us. If anyone has suggestions on how we can improve this process I am always open to improvement. Thanks to everyone, Bill, Janna, Robert, DeWayne and all the others who have been so supportive of our work. Ailene

I am sure each clinic is different but the way we do this at our clinic is, if the patient pays for 2000 follicular units and 2200 are harvested, they are all implanted and there is not a bill given at the end of the surgery. The exception to this is when a patient requests Dr. Cooley to harvest as much as he is able to and if it is more than the agreed on amount they are willing to pay the additional fee. At no time are grafts discarded. Regards, Ailene

If you add Rogaine or minoxidil as Janna is suggesting there are a few things to keep in mind. This medication does not have the same function as Propecia and in no way replaces it. For lack of a better way to describe what it does, it kind of acts like a fertilizer. But it has properties that syncronize the growth phases of hair growth so it is something that should not be started and stopped. Your hair is kind of like a cat with 9 lives and if you fertilize and make it go into an active growth cycle and then remove the fertilizer it gets confused and can shed, a lot..... and once gone may not come back. So the message is be committed. The company will tell you that you need to use it twice a day and if possible this is the recommendation but can help used once a day, BUT, use it everyday. Dr. Cooley does not like to split Propecia. He does agree with Dr. Beehner about the need to dose daily. His approach is the pill is small, not made to be split and if split the amount of med in each piece may not be equal. He recommends every other day one pill. It seems the DHT is surpressed for much longer than 24 hours so taking it daily may not be necessary. Ailene

Thank you Janna! I think the work speaks for itself. But, I forgot to mention that on this case we actually used a combination of both needles and blades. Dr. Cooley does a blue print and customizes it with the incision size according to what we are seeing in the dissection (number of 1's, 2's, 3's, 4's). Regards, Ailene

Hey Guys, I am going to try to answer this question and also try to attach a photo (remember I am challenged in this effort so be patient.) The photo was taken at the follow up at about 24 hours post op. Blades versus Needles We have used both needles and blades for many years. In a large number of patients, we have used both and see no difference in post-op healing or redness. When patients come back in for followup when the hair is growing in, there is no difference in the appearance of the hair in blade areas compared to needle areas. For grafting in hairless or shaved areas, we prefer the blades which we custom cut depending on the width and depth of the grafts. Since most of our patients do not want us to shave their heads and expect to be back at work in a week, we are often grafting into areas with significant hair. For this, we prefer the needles because the sharp point can be directed precisely and the larger caliber of the needle 'pushes' the hair apart, minimizing the risk of shock loss. We use different size needles ranging in size from 19 gauge being the largest and 22g or 23g be the smallest. Whether using blades or needles, technique and sharp instruments are critical. When making the sites with either instrument, it should feel like cutting through butter (I am told) and the depth should be controlled. We use a very sharp brand of needles which is much sharper than the standard brand an more expensive but worth the price. This is what determines trauma and post-op healing, not whether it is made with a needle or a blade. If any resistance is felt, the blade or needle should be switched out for a fresh sharp one. Anyone who has assisted in this procedure and has slivered or cut knows that blades and needles will dull very quickly. This is caused by the tissue and the fluid they are subjected to. We like having the option of using blades or needles (or both) to customize our technique for a given patient. Hope this helps. Ailene PS Let me know if I was successful in this attachment!

nw2, I would still discuss this plan with your surgeon. Treating the area first is very important. Future treatment is the question for your doctor. Many docs use a steroid during surgery to inhibit swelling. It can be oral or it may be an injection given during or after surgery. It can even be in some of the solutions used during the procedure. Any of these would help to keep the psoriasis under control in the crucial post op time. Regards, Ailene

You want to treat the psoriasis prior to the transplant and have it under control. Ask your surgeon what his treatment plan is for returning to normal treatment after a surgery. Ailene

It would work for identical twins.... but the twin would have the same hairloss.... so the only time they would probably be a willing donor would be after death...... Not a good thought! Ailene

Our post op shampoo instructions on the day of surgery are to not do anything except Dr. Cooley's spray (no I can't tell you what's in it because he changes all the time). At 24 hours you aim the water below the neck, take a cup and put shampoo in it put it under the faucet to create foam and pour over the grafted area. The donor area you can wash normally. Rinse the same way. This is the instructions for 7 days. We feel it takers a full 7 days for the grafts to be well seated. It is to allow time for healing but also keep the area clean. The spray hydrates and helps with healing and itching. Ailene

Spot is right. Use gentle shampoo's in this healing time. The medicated shampoo probably would cause no damage but it is always better to use caution. You can start back at one month with regular shampoo's. Ailene

Think about this guys, smoking decreases the amount of o2 your body pumps through it's arteries. Think about smokers and wrinkles and overall skin condition. Your hair lives in your skin and is fed by the blood supply. Smoking chokes the hair. It does not cause hair loss if you do not have the predetermined genetic programming for DHT but it does have an effect on how fast it happens. (Just as it effects how our skin ages) It also has an effect on hair growth after a transplant. Transplants work in smokers but they seem to grow in slower. There are lots of studies and discussions at the meetings about decreased growth in smokers. Just an FYI. Ailene

Dr. Cooley recommends using caution with blow drying. You can dry the sides and back normally but the newly grafted area he prefers that you use as little heat as possible. Dry on a cool setting and be careful with a brush or comb not to do any damage. Good Luck, Ailene