Dr. Mohammad Humayun Mohma

Well I have seen Stromhold pictures and he is 23 with type v to vi MPH. He does not have a strong family history of big type VII MPB. I will have no reluctance to operate on him provided I see no miniturized hair way down his donor area. My cut off point for any one with advance Hair loss is if I cannot harvest more than 4000 grafts in his life time. If some one who is young but has a well developed hair loss and no obvious signs of miniturize hair in the viable donor area with especially the nape of neck then I believe its pretty safe. They do have to understand one point is they will never ever have their crowns covered and have to live with the crown baldness. If they agree with the thinness of about 30 grafts/sq cm along with crown baldness, i think they are candidates no problem. The problem with young guys start when they start demanding to have a hair line about 5 to 6 cm from galbella and cannot or will not compromise with the density and will force you to cover or commit the crown area. They are the ones who should not be touched till they reach either 28 or 30 or they grow out of that density issue and are ready to accept lesser density. so I think have talked to stromhold over telephone, he seem to be reasonable enough gentleman who understand the limitations of the surgery makes him a very good candidate. the only think that I have to assess is the availability of the minimum of 4000+ grafts. so that is usually done when i see the person

do not worry, as far as the grafted area do not get infected nothing will happen. flu is viral in origin and it does not compromise with the surgery.

I think you have enough donor area left that can harvest another 5000 to 6000 grafts, if I recall your true donor area and I am sure that should be enough for covering anything about type VI MPB. unless you have a very strong family history for type VII MPB. So in all fairness, no you are not risking too much.

Dear LW this is one of the example of my patient who had a poor growth initially and then after second session he recovered, since then he had a 3 session. http://www.hairtransplantnetwo...ientID=1913&DrID=469

Dear AMMO Tell me how many doctors in this forum say categorically that they can give dense packing one surgery result for more than type III MPB. The reasons no one will do that is because He has to see 1) The Area to be covered 2) The donor Density 3) The donor mobility 4) the paying capacity of the patient. You do need to understand one thing if money is the criterion then one surgery gives you more profit for same number of grafts then 2 surgeries. As for two surgeries your fixed cost becomes double. So if anything with respect to mills of hair transplant I am on a loosing end. I do not consider money as my prime target, its a bye product of name that I want to have. I want to be the most respected doctor in my speciality. So please give me a break with one surgery dense packing thing. Simple mats measure the recipient area in cm, then multiply that with minimum of 40 to 50, this will give you a rough estimate of how many grafts you need for a dense packing. Please also remember there is a difference between science and arts. In arts they do not believe in one go, you always need to do a small touch up and that small touch up can actually make all the difference. regards

LW I have asked Nawaz to get in touch with you and facilitate you with your plans though it would be great if we can wait till the end of 10 months that would be summers. He told me that you did discuss with him the summer thing as well. So hope to hear from you and once again, I do apologize for the poor growth.

Dear Little wolf I am sorry to hear that you have gone through this ordeal and I wish none of my patients have to suffer with poor growth. I know how hard it would be on you to have gone through the surgery and then this disappointment. I know its too early but I also know that it wont be that great either as I and you thought it would be. I do accept the failure of the result irrespective of the cause, I take the responsibility to this surgery and offer you a complete free surgery and also the cost of staying in Islamabad for 2 to 3 nights that would incur on you for having this surgery. I would also send you one case similar to your self after one surgery and then a second surgery result as well. Now Mr Khizar, I know you are concerned about the outcome, as every one else has been, but you seem to be very biased about me. looks as if you are working for the doctor you had the surgery done from. it was just a feeling, I am sure I am wrong about this but your concern is right, its just that i can smell a bit of biased opinion from your statements. I think if you can stay impartial like all other have been it would put more weight in your comments. with respect to 3 surgeries or four I can do, I think I am good enough to do that. I said, I only spend 1.30 hours with each patient and the experience of my techs per theatre put together is more than 18 years with the main person is 9 to 10 years. They have assisted me in over 4000 surgeries more than any other doctor in Pakistan as I started in year 2000 and was the first one to start in Pakistan. Since 2002 I have been giving lectures on almost every topic of hair transplant surgery at the two most prestigious hair transplant forums, ISHRS annual meeting and orlando Live Surgery Workshop. so I can easily say i have not only a very experienced team but I have a reasonable experience as well.

Dear Romeono1 i am pretty open about my self. I know people do a lot of one stage hair transplant. I am two stage surgery, i think I can produce more density in two sessions with same number of grafts than I can do that in one session. Hence i have started to do two sessions. This is more hassle for patients but better results. May be that is one of the reasons I am getting more surgeries as i tend to do more sessions per patient than others but the patient satisfaction rate with higher grade of hair loss is more with me as well. You cant judge me based on my one session result as I always plan from the point of view of two sessions. YES, if you do not do the second session the results are thinned out but looks very natural and no unnatural effects are seen. I have posted once again the reasons the grafts might not survive in your other post.

Dear FG I believe that if you manage the time well, and I am hopefully if accepted will present my paper on time management in Hair transplant. The time taken by a physician in a surgery is not more than 1.30 hrs, so if the time is managed well one can do two surgeries by adding only 25 more minutes to 1.30 hrs, in other words if you are well versed with the technique and have a good and sound surgical back ground, one can easily do 3 to 4 surgeries in 4 hours of physician time. You have a fresh team for each theatre so the techs are 4 per theatre you only have to spend 4 hours to do 3 to 4 surgeries. So in this way one can reduce the over heads and hence the price for the patient so every one wins Mind you the quality is the main issue so no compromise on the quality. Keeping the quality at top priority, i am sure if one can manage why not. Mills of North American are also in every part of world but not all mills are of poor quality. Some can do good job with reproducible results.

Dear Romeono1 If you read an article from Dr Parsley Norwood and shiell proposed that X-factor(unexplained poor survival of grafts beyond control of physician) plays about 1-3% role in every case though in rare case it has a significant role to have an impact on the result. these are the following things that one need to consider for graft survival 1) Selection of patient with good donor area 2) Selection of patient with good and healthy recipient area 3) Avoidance of direct and indirect trauma 4) graft size and method of site preparation and graft size 5) storage of solution 6) best post operative plan 7) Hydration of the grafts during the surgery 8) Physical trauma of grafts while holding and planting 9) Cold Ischemia (Time out of body) 10) effect of density 11) skinny or chubby grafts 12) type of incision In short the graft survival does not fully depend on the tech or doctor but its every thing Patient, Doctor and tech not to forget the X-Factor which is beyond any ones control. I hope this will help you to understand the technicalities of hair transplant surgery.

Well I would like to tell you about time management in hair transplant surgery, in this way you can actually do 3 surgeries a day and still manage to finish your work before 1 pm. This however, can vary from one doctor to another based on his/her expertise. I have three theaters and my patients come at 9.30 to 10 am in office. I take first patient to theatre 1, take pictures and draw the hair line. (this takes 10 to 15 mins) I then go to theatre no 2 and do the same in the mean while the first patient is given local on the donor area. So I go back to theatre no 1 and take the strip (15 mins) then I go to theatre no 3 and take pictures etc and then go to theatre no 2 and take a strip and then theatre no 1 to make sites, takes me about 30 mins for site making. Then I go to theatre no 3 strip and then theatre no 2 sites and then theatre no 3 sites. So I start my surgeries by 10 am and finish my part of work at 1 pm. Then I do few consults for cosmetic surgeries and HT if needed. All my hair transplants are done by 4 to 6 pm. It is at this time around 4 to 5 pm that I do almost one cosmetic surgery 2 out of 3 days. My day end at about 7pm. If some one knows the art of managing time its very easy and without getting tired. Now to the second part I personally think that what is important in HT is not how you do it but what is the outcome. The key is that it should not look unnatural, the hair line should stand the test of time (means with passage of time and hair loss t should remain natural looking though thin) the donor area should be minimally scarred so that if he wants he should be able to trim the hair not exactly at no 0 trimmer but about a cm or two. Though the idea is to make it possible to trim the hair as short as possible. No two scars etc. It really does not matter to use sophisticated machines. At one time when we did not have so many gadgets we had clinical acumen and we use to use our clinical judgement more, now all we do is send for this test and that test spend 1000's of $ and then diagnose its a common cold. now, I understand its a evidence based medicine as well, but again the idea is to treat the patient. what I have noticed that so many people use these expensive tools just to promote themselves but their work is less than what I call is natural looks. So whether chubby or no chubby, microscope or no microscope, if the doctor is doing a standard job he should be given the same level as others. The criterion of membership should be based on the outcome of his/her results.

Dear Romeono1 I have total of 18 techs 3 of them started with me in 2001 1 started in 2002 4 started in 2005 6 started in 2007 3 started in 2008 1 in 2009 one of them have just left. so this is the experience of my tech, I divide them in 4 theaters with 1 team leader of more than 8 years, one each with 5 years and then mix. The rest of extra fine was answered to you by my consultant Shahid jamil. Please feel free to ask what ever you want.

Dear Romeono1 It was brought to my attention about your thread and concerns. I do think you have asked me this question before either on an email or tel call. Let me tell you my point of view about your so called depth control titanium punches that you have been asking for. I know some people in World are using the punches but presently none of the top cadre of the surgeons are using the punches reason being they tend to heal with a visible pitting effect especially in a south asian skin. I have been using them and have stopped that 8 years back. the depth of the instrument is not that important as it varies from patient to patient and even with a depth control if you press hard then you can go deeper in spite of the depth control instruments. So most surgeon use depth control for them to feel the little resistance that it offers and that is all they need. Trust me that depth control is mainly for beginners and if you ask any of the top surgeons they would not weight the depth control as important factor. I know that doctors have used simple sharp point needles and also simple 18 gauge needles which does not have a depth control instruments attached but produce a great results. So with due respect that is all selling gimmick of a doctor who has told you about that and I know who is that doctor in Pakistan anyway, because he tends to brag about that depth control titanium punches but i respect his choice but do not agree with that. Second about the extra fine follicular units By definition, extra fine follicular units means all the fat has to be removed from the follicles with out damaging the follicle. It does not mean to split the naturally occurring paired follicles in a follicular unit. YES we do remove all the excess fat and by definition it does become extra fine follicular unit. No I do not split the existing paired follicular unit as In my view its a cheating with the patient and a tool of making more grafts and hence charging more. Now coming to the patient dissatisfaction I acknowledge that certain number of my patients wont be happy in the first instance for the simple reason, I do not do very dense packing and I am a two stage surgery guy. If you need 4000 grafts i will do that in two sessions not one session. I know people might not agree with that but in my hands 4000 grafts in two sessions have about 30% better results than in one session. Now, I also acknowledge the fact that some percentage of my patients and for that matter any surgeons patient would be un satisfied with the yield issue and there are reasons that are due to surgeon and technique and also that in some cases its not know usually referred as X factor. Irrespective of the reason I take the blame for the poor growth and in my clinic what i have done is, lets suppose we have done 3000 grafts and on a rough estimate the patient says that the result is about 80%, I give guarantee of 90% so in that case 10% grafts are less than promised, so i will not only give him that 10% that we fail to give but also give him an extra 10%, in this way if the surgery is 50% then he gets 100% free surgery. If he does not get any result and he does not trust me any more then i give him full refunds. I have done over 4000 patients and if I have just 5% un satisfied patient it will be 200 patients and 2% will amount to 80 patients, 4 is not that high numbers but for me every patient matters and therefore I stand behind my patients in every way. The only thing is you have to be rationale to discuss the options with me and I have never claimed that I am a perfect guy, I just try to do as good as I can. I am learning, it is now 10 years and almost for last 8 years my papers have been accepted for presentation in ISHRS meeting, this means a lot in terms of medical profession. I am sure if you ask any doctor that if some one is for 8 years been presenting his work at the international level is that good or bad. I am sure I am doing some thing right that my clients are getting more and more. i do about 3 surgeries a day and my waiting period is not touching 3 weeks. This is only because I have developed a strong system and a reproducible results that looks natural and good. But this certainly does not mean that I am the best, this means I have yet to work hard and improve on myself. Mind you I do not agree to certain rules of this community but I respect those rules and in order to be in this community i have to adopt that. In the end, every thing boils down to one factor, am I a ethically practicing doctor who cares for his patients and are my results compatible to the minimum acceptable results in terms of growth and naturalness. I say, YES I am. If you do have certain issues with respect to technical points in Hair transplant, I would be more than happy to answer those for you in depth and in the way i believe in them. I am sure I will learn from your comments as well.

This young gentleman had an issue with no temporal peaks and no side burns with minor recession of hair line. He was mainly concern with the creation of temporal peaks and side burns and just to enhance the hair line if possible. This is results after 1 year following 1962 grafts.

Dear Dr Madhu I agree with your description of donor area and mobility check. What I have reservations are As we all know that Donor area is limited and it has to be above the occipital protrubence and minimum 1 cm below the miniturized hair of the occipital area. now usually this donor area is not more than 3 to 4 cm depending on the type of baldness. I refer this as true donor area or viable donor area. If you want to do two scars there has to be at least 1 cm of good skin with dense donor area. So if you leave a healthy strip between two scars you might be at the edge of donor area where the thinness will start and the patient will loose all the grafts that were harvested from that donor area which now over the period of time has gone bald. I am sure we have seen so many punch grafts of previous time having these problems. This is one of the reason I am not a fan of FUE that you tend to go to these non true donor area for harvesting grafts. Second, I am sure that the best way is to evaluate the mobility of the entire donor area, but if the mobility is there then you can always take more strip. If the mobility is not there then even if you go a cm or two below or above the previous scar the wound dynamics will not change, so there will be high tension on the scar and hence more chances of having one of them going wide scar. Mind you, even one strip cannot guranttee the fine scar irrespective of whether you do tricophytic or not. So my point is why to take unnecessary chance on patients for the sake of 1000 1200 grafts. a single wide scar is not worth the risk. I try to be very conservative but still fail in 1% of cases and it is for the safety reason that I am a two surgery man not one stop surgery. I know some greatest names are one stop proponents but in my hands, I can produce better results with 4000 grafts in two sessions then doing 4000 in one go. I feel that by doing two scars in one go, I am taking about 50% more risk than normal cases. Plus I also think that in future there would be more chance of these patients to have visible scars then ones with single scars. I feel its better to be safe than sorry. If some one cannot understand two sessions, I have not done those patients. I think they are not ready for hair transplant in my view.

Dear Friends I was told about this thread by one of my office worker. Generally, the reason for necrosis is only one thing, insufficient blood flow to the most middle part of the recepient area. Main cause is smoking but as he is not a smoker, that certainly is not the case. Second cause is dense packing, but I am usually not a person who is dense packer so most probably that should not be a cause. Third is when we use epinephrine and tumucent technique, this epinephrine that tends to reduce the blood flow last longer than it should, ever one respond differently but this is a very remote reason. Anyway, irrespective of the cause, which in this case I am not sure of, the treatment of necrosis is simple supportive. and it is treated conservatively and usually it takes about 6 weeks to heal, i am not sure why it has taken so long. Some times there are certain issues of healing or may be rubbing off the scab, so new is formed. I think the best thing would be to see a doctor just for the sake of why its taking so long, but the picture does not show any evidence of infection, so no need of any anti biotic. this area will be devoid of hairs but then usually i do cover it up complimentary. By the looks of this scab, I am not worried at all. just that it has taken so long make me wonder why taking so long. I am sure if that will also answer why it happen in the first place as well. but I am there for the patient as always.

Hi,I agree with arnolder that hair line is not natural and easily recognizable.One can not expect such bad hair line from this Forum Recommended doctor. -Why this patient need 2 sessions while this can be done in one session? -Even after getting two sessions the density is poor. -If you look at the frontal hair line,there are two hair as well. -My impression is that it is not quality work rather it needs lot of improvement. -Keep it up and try your best to give good result. -This patient is young and baldness seems progressive ,are you taking young patients as well? -My purpose is positive creticism as one learn from mistakes,not to hurt honourable doctor. Khizar Dear Khizar I respect your opinion and I am glad that you have looked in so detail. To have one or two grafts of two hairs in the front hair line is actually not un natural at all. I do remember Dr Ron Shaperio in His lectures of creating a natural looking hair line showed his own close up picture and we could see two hair FU right up in the front. Ofcourse, we try our best not to make it but as humans we are bound to have errors. Second, YES its not a dense packing hair, if you see him, his area to be cocered is about 15 x and depth is about 9 cm if I include the temporal peaks the total density should not be more than 31 grafts per sq cm. This is exactly why i am careful with these young patients. Now your answers 1) I know people do it in one go, I dont. I have tried, in my hands I can give a better illusion with 4000 grafts in two sessions then I can do in one, so if I do in one session i save more money but its about better results so I do it in two. Actually patients pay per graft so 4000 in one session be same as in two. 2) The density is poor, I do not believe in high density, i believe in optical or visual density. I do not give them high hopes of looking as dense as they were in 20's. so sorry but if some one wants to come to me they have to accept visual density results. 3) I am sure I need loads of improvement and that is why i would listen to you. your criticism means a lot for me even if you are doing it from bad intensions. 4) I am trying to improve and every time i am told i was not good i improve. Kite rises against the wind not with the wind. 5) YES, I do take younger patients. But i am careful with selection. there is no hard and fast rules in field of medicine. there are exception. If I know the family history of the patient and baldness prevailing in family, i look for the miniturization process and feel for the true (viable) donor area. Then I play safe, do not lower hair line below 7.5cm from glabella. 6) the very statement saying that your purpose was a positive creticism actually means you had some sort of guilt in your mind. It goes without saying that all people in this forum are only trying to give their positive criticism, so if you have said that, it actually means you had some other thoughts while you were writing all this. Having said all that, i am open for both positive and negative because I know what I am doing and i do my best to improve on myself. I am still a learner as compare to some very very big names.

we charge about US$ 0.70 per graft presently due to exchange rate.

True I was just referring to hair transplant

we charge Pak rs 60 per graft its about 0.70$ a graft.

Just to add to the dubai clinic I have been given the license now I am in a process to set the clinic and I hope that latest by April, I should be starting the operation in Dubai

the time between the pre op and post op pictures is two years, so he has gone thinner since the first picture that should be kept in mind as well.

CORRECTION the flash was on........

The probable reason that this was not looking as good as it should be is 1) He had oil applied on the scalp, I do not remember I was having a flash gun on. This density is not more than 30/sq cm, as I do not tend to do more density to keep the future donor area available. This is only optical density. With respect to camera, its Nikon D90. But as I always say its the man behind the gun which is more important not the Gun. Having said that, the size was 510kb and the web site does not take that larger than 500kb, l so I had to reduce the size and I am sure that could have been another reason, but i am trying to improve the quality as much as possible. I am actually in process of making a studio or special room for pre and post op pictures. Hope that would resolve the problem. improvement is never ending story

This Gentleman had two sessions each of 2207 grafts and 2047 grafts and this is 1 Year follow up. He is quiet happy with the results as it looks very natural and people cant tell he had some thing done may be just mild thinness.