Dr. Mohammad Humayun Mohma

4 as in 4 techs not the number of surgery.

Second Ask any doctor is 4 not the enough for any surgery that is not more than (on an average) 3000 grafts, with no dense packing. Ofcourse with dense packing, the techs have to work harder, I dont do any dense packing, not more than 20 to 25/ sq cm...... dont you think that makes the life of a tech much more comfortable.

Well I do see the concern of people with respect to the number of surgeries. TELL me one thing, if for that particular team you are the only patient. They are with you all along the surgery. why are you concern that there are other surgeries being done in the same centre? For that team you are the only surgery they gonna perform that particular day............ Can some one answer me this please ONE TEAM ONE SURGERY................no tech is taken off from the theatre......for them and for you that is it?

I have been hurt in this forum in the past but, I learned from it as to how to improve the standard of my clinic so that I can be compared with the best in world. Lets see the positive aspect of this conversation. We learn from the mistakes we do, and I think we should be in a way thankful to the forum that they do bring out some times such an issue that has nothing to do with the quality of results but general principles. After all if we are in the forum that represent the international group, they need to see if we can come up to same standards as every body else. YES due to the cultural and economical difference we might be doing some thing that is norm in our land and not norm in USA then we might have to learn or teach but instead of leaving the forum we have to be a fighter and at the same time get the positive aspect of that issue. I always see the brightest aspect of all issues and I do respect this forum from whom I have learned few things. Every time I am down I rise, with even more determination. I ill close my remarks with the quote from Notingham , UK "Rise and rise again, till the lambs become the lions." I love this. so my friend lets be thankful to this community to make us Lion.

Dr Madhu I am sorry once again and Actually what I realize that when we as non english speaking people tend to give any comments it can be misrepresented and I have already apologized and cleared my point of view. It was not based on any one but in general and I am sure that all of us will agree in general terms that what I said is not wrong. I have last night and I do even now once again apologize for hurting your feelings but I never meant that way. Bill did send me a message and i did clarify my position over there with him and now on forum. I know how it feels when your position is not being understood by people and some one is throwing the mud on you. I have been a victim myself and that was precisely why I came back straight away to say sorry. I hope you will forgive me. Over the period I have learned the less you comment, the less you get into trouble. My medium of education has been English but I can still say things that could be taken in the wrong direction.

Just to clarify one more thing. My reply was in general for who ever do such practice and as I do not know whether Dr Madhu has any of such practice so I feel sorry that my comment has been taken in the wrong direction. It's a general rule. Dr Madhu, I believe in my true spirit that you are not doing such thing and I apologize for a reply that you might hav taken it more personal. But they reflect my personal feeling not against any individual.

Dear Bill I do agree with you. I should not have been so irrational and without knowing that the person who is saying this could be any one. So I apologize Dr Madhu in public and I should have asked him or rather not commented at all. So please accept my apology.

Dear imun I have a strong reservation for giving a second scar. The scar you see is the result of my tricophytic closure technique and it is always included in the second strip. These scars are the reason most of my patients opt for a strip technique and not the FUE. I do not compromise on the quality of scars for the number of grafts. Mind you this gentle man was Type VI ish and will have a minimum of 250 sq cm area to be covered. so it shows that I would not have gone beyond 20 grafts per sq cm. Now you see the strength of doing two session as oppose to 1 session. you can do a strategic placing of grafts and can get a great result with minimal density. See the angles of exit and also the naturalness. doing all the things with only 4700 grafts is not that easy.

Dear Friends Shangla asked me to comment on this issue. Well lets start with one thing. We have 5 theaters for operation but Now I do only 3 surgery in a day but rarely if pressed I do 4 surgeries no more 5 or more. So I have 17 Tech 12 in Islamabad, 5 in another close by city of Peshawar 2 hours drive So when we have 3 or 4 surgeries each theatre gets 4 techs. My time per patient from designing to strip and site preparation id about 1.30 hours. so if i Start a surgery at 10 am then my work with all 3 theaters are done with by 2 pm max. Most surgeries take about 6 hours on an average its takes on an average of 4 well trained tech with more than 5 years of experience about 1 to 1.30 hours to cut about 600 to 700 grafts easily. by the time the cutting and counting is done its about 1.30 pm. here 30 minutes of break is given to the patient for a light snack and by this time all the four techs or especially the first pair will have an hour break and also had their lunch. they will start planting and in one hour time the second pair will come and start doing the surgery while they will have an hour break with tea or coffee. and this goes on for about 4 hours. so in essence each person will do on an average of not more than 4 hours. so is this enough to get fatigued? I think your stamina needs to be improved my friend. Ok lets see some other well know doctors, they use between 4000 to 6000 grafts per session and if you ask them they have about 7 tech and they take about 8 to 10 hours some even as long as 12 hours with even larger numbers and I am sure lot of those data are available in the forum. with 7 tech each tech will be still doing not less than 4 hours of proper work. so whats the difference? I on an average do between 2500 to 3000 garfts some times much more but then those days we do lesser number. I do not see any problems with the time. my tech come to clinic by 9.30 to 10 am and usually they are gone by 4 to 5 pm. any problems with that time, i guess no If still some one do not want to come, who is forcing them. YES, I have few less than expected results but then who did not? I have more than 98% well satisfied patients and that is why I am doing well. I do about 700 to 800 surgeries a year means about 7 to 14 less than perfect results can be expected and fatigue is not the only issue here my friend. Why the rest of 98% are so happy. If you remember and go to Abby's blog, he was so scared when he came to know that I do not use even a microscope, but ASK him what did he say before doing his second session? Doc its OK if you do not use the microscope cause by that time I was using it but for slivering only. I respect your opinion but I am sorry, I do differ with you. 4 to 5 hours of physical work is a fatigue.......may be the techs who get fatigued so quickly are not been looked after

I was send this mail to give my honest comments and here are my comments as an unbiased man. I think to have ISO certification is good. now he might have been a bit irrational but I do not see any problem with that but, i wish it would have been done properly. so YES, I agree that it was not a right way to do things. I have previously commented on that issue. All of us can have a good or bad scar. So quality of the scar is not an issue at all. we are all surgeons and have good or bad results. But I cannot accept two good or bad scars. Having two scars just because a patient wants density and bigger session does not justify doing two scars at all. But then he is not the only one who does this. There are loads of other doctors and some of them have openly say it at the conference. I am strongly oppose to this concept of two scars. I also have no issues of shaving the recipient area before hair transplant or not shaving it. But I do not like the idea of charging extra 400$ for that. I agree it could be a policy already explained in a consultation but it does not seem to be a fair game. Because, all this is to save time. Doing plantation between hair is slow and time consuming so this is how they charge for that time loss. I do not see this as a professional way of practice. Please do not mind my words this is what I am, before being a doctor I am a human and a professional man. so I feel this as a way of charging more than what one professional doctor of high moral values should do. Once again this is totally rubbish. I will use a dissolvable or permanent suture based on my clinical judgement but on a special request I will not charge that person extra money. Again the reason is that dissolvable suture take twice as long and non dissolvable ones. Any person who can cheat a government can cheat any one. so if any doctor does not give receipt, he is not a true professional man. Now ISO 9001 has nothing to do with the honesty. I would ask Dr Madhu not to do this and rob his country with the TAX he deserve to pay. In my country the economy is even worst than India, people do pay me cash and some high ups even do not want me to give them a receipt, but we give receipt as a policy. As I do not want any of my employee to think I am hiding the money as all my employee gets a share from the profit, they deserve this because they play the most important part in my success as a team. But TAX EVASION is a crime. I hope this was enough. As far as US or WE, irrespective of that wrong thing is wrong. we cant keep on ignoring the non-professionalism in our community

I understand your concern of doing more than 1 surgery a day. I have 4 theatre suites and each theatre has 4 tech. The senior most tech has between 8 to 10 years of experience then two tech has between 5 to 6 years and the forth the youngest is about 3 years. so the work start by two youngest help me with the strip, it takes me 15 minutes or less to do a tricophytic scar closure technique for strip harvest. while we are doing this the senior two tech start slivering the strip. then i go out and in 20 minutes i return when the recepient area is injected with local anesthesia. It takes be on an average of 20 minutes to 25 minutes to make between 2500 to 2800 sites. then all the four techs keep on cutting and once the senior most do 400 each grafts that takes them about an hour, they start planting the grafts. its usually with in 6 hours the procedure is done. The staff comes in pair, the front is done by most experience and the junior most start from crown and gradually start on front after having minimum of 500 surgery experience. so there is no tech fatigue in my set up. every team works on only one patient a day. so , if some one thinks there could be a problem in this, i would be more than happy to answer that.

Bill i have been lurking on this forum for about a year now, all of your comments about dr humayun have been that he is great doctor and well stand behind his work.Well that is just peachy but i have yet to see any one coming back saying that the patient did return to the dr and he did stand behind his work.How do you know he stands behind his work ?? Dear SM535Q We use to do about 4 to 5 surgeries a day.. now since this year i have brought down to about 3 a day and very occasionally 4 a day, not because I do not have the patients but because, i was involved more with flood relief and try to set up a free school and a clinic in a remote village where i belong to. anyway, why i mentioned all this is because if out of 800 surgeries a year, if i see only 2 to 8 person with less than ideal results means really nothing. there is no surgeon with 100% results. we all have less than ideal results and the percent age should be less than 2%. in other words if you have more than 98% success then you are very good. I am no exception to this. The way i stand behind my patients is i give them a complimentary surgery. If you wait long enough little wolf is coming for his second surgery soon. As he is not from Pakistan, we are not only giving him a complimentary surgery, we are also taking the cost of boarding and lodging and also paying him 50% of his economy class ticket to Islamabad. Now if you do not call this as backing up the patient, i would like to ask you, what do you think is backing up? mind you he has a result which is about 50%, so I think this is a very fare way of showing to the client that we care for clients and not money. you tell me ONE surgeon in the world who would do some thing like this. Anyway, you have the right to decide which doctor you wanna choose. I am just another doctor who wants to have a good reputation and thats it. I dont wanna be the rip off doctor but a one who cares for his clients .

dont take me wrong in way that i am against the FUE procedure. I am just cautious about using it. its a great procedure especially with motorized versions. Much less fatigue, easy to harvest, less trauma, and less collateral damage.

there is a difference between being least invasive and quickest to heal. I agree that the scars are least visible. if we use 200 FUE and then talk about 3000 its a lot of difference. I also know that people are using 0.7 mm and some using 0.5mm. Now i might not be very skilled but i fail to understand the physical dynamics of a three hair unit can actually be accommodated in a 0.5 or for that matter 0.7 mm punch. The feeling of going deep is no doubt is there but most of the punch will go about 5 to 6 mm deep. and most of the follicle is about 4 mm to 5 mm. its simple procedure that you need to go deeper than the follicle bulb to make it release it without damage or having the problem we call the decapping. now with latest motorized versions of equipment the vibration of the machine does not allow you to feel that give that you were mentioning. I do it and i know how it feels. fair enough i do not do a large volume. regarding the economics in FUE, you spend 5 to 6 hours of surgeon time as FUE should only be extracted by surgeon. then it is transplanted by maximum of 2 tech. the price difference is 3 times minimum. the expenses of procedure is almost half including the number of blades needed to prep the grafts, the extra staff. so all in all you safe more. if not with other doctors in my practice I safe more with FUE then strip even if i do 4 strips in a day as oppose to 1 FUE in a day. this is statistics of my clinic, i might be then different. most of the doctors who are in FUE are actually going above and below the true donor area, simple fact is, the true donor area will fetch you about 6000 follicles that can be done in strip. if you do FUE, you take 1 in 4 follicles to maintain the minimum donor density to look natural. so if you do that you cannot take more than 2000 grafts. but then there are people doing more than 4000 FUE. now i am talking about type 4 and above MPB. ofcourse if you doing it for type III or so, then the question arise on the future of hair loss........... the true donor area in most cases cannot spare more than 7000 grafts in a person who can potentially go more than type V to VI MPB. YES in few individuals it can. i am sure it will get better with time. there is a doctor who thinks he take a small core out of a follicle without damaging the follicle and hence he claims he is doing a cell multiplication/cloning. I respect him but i am very sceptical of him. i have not seen a great improvement in his pre and post operating results. i am just sharing my thoughts as a surgeon. I might be not correct but this is what i believe.

its highly unlikely that one person can have three surgeons and all three not doing good job. There might be some other factor which is common and not giving you a good result. Usually i think if you do not see any out come by 8 to 10 months nothing major will change in next few months. having said that, smoking is one factor that can reduce the hair growth significantly. Humayun

we do offer FUE but you need to understand that there are quiet a few questions in FUE. I delivered papers on FUE way back in 2003 in ISHRS annual meeting in NY. so that means I was doing FUE even before that. so why should I not do FUE or be very enthusiastic about it? the answer lies in the arguments below 1) every doctor have to go beyond the limits of true donor area to harvest FUE, the question arise knowing that these follicles will shed early as soon as baldness progress, is it ethical to do the same procedure then? 2) People say FUE is less invasive. My argument is when I am doing a strip harvest, i see the bottom end of the follicle and stop there. where as in FUE as it is a blind procedure i go a bit beyond the limit of follicle to release the tissue. so in real terms its more invasive than open strip harvest. 3) People promote it as scar less, i want to know which doctor in the world call it as a scar less. in strip harvest, you have 25 cm long 1 mm wide strip in most of tricophytic closure technique. with 2500 grafts. now lets imagine we are doing 0.9mm punch FUE and 2500 grafts. means 2500 x 0.9 mm scars and if we want to calculate the circumference of these scar multiply it with 2 phy r. it will be 141.42 cm. about 116 cm longer than the strip harvest. YES, i agree there is almost no pain post op. is that the only reason. I think, it gets that much of publicity because it gives a surgeon more money per graft to take home then strip harvest. Doctor say in FUE he has the liberty to choose the triple hair grafts, have they ever calculated how many triple hair grafts have partial transactions means one hair transacted among three. means 33% damage... so can some one tell what is the true transaction rate in FUE...... you see, as a Doctor, i have to be very unbiased to tell the options of hair restorations to a potential clients. There is one person who came to Pakistan to pay me 12000 $ for a 4000 grafts FUE, i told him all this and he ended up paying 5000$ for same number of grafts. You ask my honest opinion about the value for money, tricophytic scar closure properly done give you less graft and value for money. Having said this , I am still doing FUE with motorised instruments. You people also need to know, i need lesser number of staff for FUE and more money. so economics are on my side if i use FUE rather than strip. now tell me what do you people say

Dear NK I think I have already asked you to come to the clinic and i will try to solve your problem. I understand your results are less than optimal. but this is where I stand beside you. Come to the clinic. Regards

seeing all your pictures i think the plan is perfect, but we must not forget one thing, the pictures are two dimensional and the reality is three dimensional which can have a very different view. So best thing would be go to a local well reputed doctor or have a video conferencing that can give us some more insight into your hair loss.

I had this persons friend done the surgery same time as you have and this is the feed back from him...... Request for an online Virtual Consult from Hair Transplant Network Patient Information for Address : City : ZIP : State :Sudan Country :Sudan Email : Day Phone: Eve Phone: Age :41 Gender :Male Degree of loss:5a Rogaine :never Propecia :never Medication History :NA Questions concerns : I have a colleague who recently performed hair restoration surgery at your clinic approximately 6 months ago which looks very professional. I am looking into the possibility of doing the same. This message was sent from the Hair Transplant Network this is how i get the referrals. But then every now and then 5 to 10 patients a year i have poor growth and that is when I prove myself that I care for you.

Dear NK I am sorry that you have to go through the disappointment of either slow growth or poor growth. As 6 months is too early to decide but I would encourage you to kindly visit us and let us have a look. As you know about 1 to 2 % of patients do get poor growth after hair transplant surgery, and more so if you had necrosis then one of the reasons is there was some thing that caused the decreased blood supply to the scalp. This very fact could also be the reason behind the delay growth or poor growth. Having said all this, I do stand beside my patients who end up having bad results or unsatisfactory growth and give them a complimentary surgery if the results is even 50%. so please do not worry and if anything I can try to help you I would be always there for you.

yep, the price goes up to same rates like $3 to $4 a graft

there are two types of tech in the world 1) those who have a medical nursing background 2) those who are what we call OT technitians and they do not hold any nursing diploma. they are trained on site and in job. generally when we hire a tech, they only observe for about 3 to 6 months what to do and how to do. In their 3 to 6 months they start cutting and assisting the surgeon to take a strip etc, it is not till the end of first year when they start doing the planing and they gradually start from the crown and finally end up in the hair line. with respect to the skin necrosis, its not that uncommon but its a sequale of dense packing or reduced blood supply to the most vulnarable area in frontal aspect. Its just one of the things and just to let you know that in this area we really do not have any very important nerves or arteries or veins that we should be really worried about. the arterial supply vary from person to person and this necrosis was the one amoung two that I have seen after 2 years and well over 1400 cases. so its pretty rare. with respect to the Dr NK, I saw him middle of March and the healing was well on its way. I am not a dense pack man anyway, so most if not all of my clients are told about two sessions. at the end of the day Romeono1 you need to understand that you are young and you want all the area frontal and crown to be covered with medium mobility and density. 2500 grafts can only do what 2500 will do, so trying to cover every thing with 2500 is asking for a bit too much. I have told you that all you have to do is wait and if there are any problem, I would always stand beside you. I am always there for you. unless I do not make you happy, I wont be happy either.

I think if Allah willing we should be up and operational with soft opening in May this year. I am just awaiting the license of my techs. slow but steady.

dear friends As presently I am in US for my 4 presentations lectures on hair transplant at the orlando live surgery workshop so I could not properly investigate the issue. I guess the issue arise first about 6 to 7 months back and as far as I know two of my staff were responsible. The one I have terminated earlier had another allegation to her so I just could not afford to have a bad reputation and hence I asked her to leave. I was just wondering if this is the same incident then I have already dealt with that but if its a new one, I will be very strict with the person named. Though i have been advised on a personal mail by mike that the best thing would be to give all the staff a meeting and ask them not to repeat it and I guess that might be right. Though I will at a personal level give a strong and last warning to the person named. Anyway, I thank you all to understand that though I am responsible for the clinic but there are few things that goes behind my back. unless I am not aware of it I cant rectify that. One more thing , unless the person does not come out in open and tell me the problem, then I am afraid I wont be able to take actions. As I am not sure that the person who is complaining is really telling the truth. One reason, people in pakistan will be more than willing to make me fire my staff as they are the most experience and hence they will be ready to take them in their team. so I have to balance every thing accordingly. Hope my point of view will also be taken in to consideration.