Dr. Mohammad Humayun Mohma

Dear Saifudheen First you cannot comment after 3 months. minimum you need to wait for about 6 months and even that could be misleading in certain circumstances. So just wait for good few months, relax, chill and enjoy your life. second, if you had max of 2300 grafts in first surgery then expecting more grafts in second is impossible.

Dr Madhu I am not convinced with your arguments. I personally still think there is no room what so ever for two scars at one or separate time. I do have very very strong reservations on that. The scar no matter how fine is still a scar and will show. I am not sure how I can predict the outcome of scar. Every time I close a scar I hope this is a good scar, as there is no guarantee. Anyway, i fear one patient who ends up with two ugly scars. it might be a statistics for us as less than 1% but for him its 100%. but as I said its just another way, and as far as I understand lots of doctors around the world do it. In this year I corrected about 10 to 12 such patients. anyway, i would suggest you to present your point of view in forth coming ISHRS meeting.

Well I think the number of grafts be exactly what Dr Madhu has stated and as i am looking at the picture only I would not be able to give an opinion. I think when Dr Madhu will respond we will be able to know exactly what he has done. Mind you having two scars or one scar is totally dependent from one surgeon to other. It does not mean he is wrong, its just that I have severe reservation to the outcome in long term. Lets wait for his opinion. I respect his views just might not agree with them. I also do not agree with those doctors who tend to give wider scar just to make sure they are doing bigger and bigger surgery. That is why I always tell people I do not believe in one stop surgery. Again my personal liking

Dear Pratik and Dr madhu I know that people would like to take more grafts. I personally do not agree with two strips from two scars as it is as bad as doing a second surgery from a donor area and giving a second scar. In my books that very very BAD. If you have good mobility I would rather take another small strip from the same donor area, I mean in the end I will assess the mobility by holding the edges together and see how easily they can be approximated. Once I know I can get another 2 to 3 mm strip, I will take it all along the strip and that would add certainly another 500 to 1000 grafts depending on the density. Then will close this donor area as one Scar. If this is how it was done I have no problems. On the other hand if two separate strip and two scars have been produced, then my friend I have very strong reservations. Its very easy to correct the wide scar but very difficult to correct multiple scars. Second you would not remain 30's or 40's, once you reach in 60's then even your donor hair will become thing and multiple scars will show through and will be much bigger a problem. At that age it will be even more difficult for you to hide that. Anyway, This is my personal view, I am sure there will be quiet a few doctors who might differ with me. Second, YOU are type VI and according to you there was 40 grafts/sq cm in the mid scalp and 60 grafts /sq cm in front hair line. Considering your facial profile you have more of round scal so the temporal to temporal area be minimum of 15 cm and the last part of grafted area be about another 12 cm (rough guess based on my experience) so we are talking about 180 sq cm area. Lets do the maths, even if I do 40 grafts per sq cm for this area, i be looking at 7200 grafts. so if you need minimum of 40 grafts per sq cm, you need another surgery of same number of grafts. just a thought. may be he told you that is what he would try to achieve at the end of two sessions. but then, i wonder, with two scar(if there are) the mobility will be seriously impaired and i wonder 3600 grafts be available at that time. hmmmmm

I am not sure who are the five doctors but as far as I remember Dr Marazola in his article hair transplant forum 15:113-16 2005 Dr Ferchet Hair transplant forum 15:113-16 Dr Rose ledge closure hair transplant forum 15:120 are the first three and I saw in Dr Patrick Ferchet lecture in 2004 at ISHRS meeting about his invisible scar and the paper was presented in ESHRS meeting at Brussel in 2005 showing that it should be less than 1cm width and at same time the other authors also talked about that. This has been there in literature but for HT this is the begining. In 2006 at San Diego meeting of ISHRS and Orlando Live surgery work shop same year I presented my work with tricophytic closure of 1.5 cm to 2cm width and minimally visible scar. Dr Parsley actually personally appreciated my work and results. So I think I would give credit of this closure technique to abouve three gentlemen

Dear Friends South east Asian have a special characteristics of hairs, they are thick and if you are not careful it can give much harsh look of hair transplant that could be detected from miles and Salman khan is an example of that surgrey. He has a good density but very unnatural looks so it has to be balanced. Now the other fact is the scalp mobility and the density of hairs/sq cm is less in asian then in caucasians. so we get lesser number of grafts. In my experience if I can get 6000 total number of grafts then i can give a great result. It can be both ways, I can fill up the front and then fill the back, or I can do what i do is spread it on a larger area compromising on the density initially, so in the end whether you do one way or the other he will need two surgeries so the math will be same. So why I choose to do so is because, if the patient for what ever reason does not get the second surgery done, he will look more odd with dense front 5 cm, and total bald in the back as compare to the one who has lesser density throughout. he looks more like a thinning pattern and can be take as normal thinness if he does not wish to go for second surgery for what ever reason. This approach was done once i saw one of my patient who was looking very odd after surgery as he was very dense in first 5 cm and nothing there after. so I asked him why dont you get the second procedure and he said he had a lot of loss in his business and he cant afford further. so just for the sake of my name and reputation and to some extent because of his story I offered him free second surgery. He is now one of my strongest advocate in Pakistan. But I learned the lesson, that i would do a surgery in such a way that if some one decides not to go for second surgery he should still look natural. Hope that would clear my point of view, though other do not have to agree with me.

Dear Dr Meshkin Thats a great result irrespective of 1000 or 2000 grafts. Its very natural and its looking good. I have never seen 1000 grafts giving such a great results. Is this patient on any type of meds? second, what was the break down of the 1000 grafts, its not for criticism as your result speaks for itself, its for my own learning needs. I do not get impressed with great numbers as those numbers will give that result anyway. I get impressed with less number and great coverage and exceptional results like yours. I Must say, given the numbers and outcome irrespective of what you use how you use, extra fine or no fine or what ever, I am impressed with the end result and that is what every body should focus on.. GREAT NATURAL OUTCOMES like yours

I feel honoured Dr Lindsey Your encouragement and remarks means a lot to me. Having differences does not mean we are wrong or right, it means there is more than one way of skinning a cat.

Dear Friends Thank you for your encouraging remarks. This is what I call selective placing of the grafts and when I use mix extra fine FU in front to create the naturalness, use the curl of shaft to bring the natural softness and use the double and triple chubby grafts to produce selective density at strategic places, I can create more density at a lower number of grafts. In this way my patients pay much less for same number of hairs as anyone else. The ultra fine FU is mainly reserved for the front area and temporal peaks that you would see in this case. Then if you magnify you would be able to see some twos and three's as well. in the middle of crown some 4's and 5's might be there(less than 5%). I know some people might not agree with me as 100% FU is a norm, but creating a master piece you do not have to follow the norms, your imagination and your techniques are more important than norms........ 100% extra fine follicular units is a science, and mixing them with few different techniques in a different way makes it an ART. I believe HT is 30% science that every Tom, Dick and Harry will do but the remaining 70% of artistic aspect of HT is where some one will shine and rest not. Its a creation and thats an ART.

Dear Hair 28 Generally HT is not as simple as 1+1=2 There are multiple factors How soft is the skin? Oozing and bleeding during the procedure? Experience of tech? thin or chubby grafts? Time of procedure? Apprehension of the patient? Actually in my books a good and well trained pair of tech should be doing about 800 to 1000 in an hour give and take 200 grafts. so that means 2100 grafts should take about 1.45 hrs to 2.30 hours difference of about 45 mins or some times if too much oozing it can take as long as 3 hours. In my experience if you are rough and not gentle you cannot place the grafts quickly. Its a paradox, the faster you are the gentle you handle because its all about eye hand co-ordination. Similarly the first time if every thing else was same and you were more apprehsive then that alone can reduce the speed by about 30 mins. If I would you, I would just relax, sit back and wait rather than worring. Dr Charles is of great repute and I am sure he will stand beside your point.

Ill be in Karachi on 27th and 28th of Dec

Dear Anaqvi I am so sorry for the delay response but in fact I was very busy, first as you know I do multiple sessions in one day, so I usually do not have time, secondly with respect to my Dubai project as well. Anyway, coming to your concerns, I have seen your pictures and what it seems that you are heading towards Type VI MPB plus your donor density especially on sides is not great at all. How young are you? what do you expect from HT Whats your family history like with regards to hair loss? If I know these three basic feed back I can tell you what you need to do. HT is a pretty straight forward thing and the basic thing is how many grafts can be transfered to the balded area. If you can have anything between 6000 to 9000 grafts in total you will be a happy man. Just remember, HT has a limit and that limit is your donor area.

Well Thank you and that is one of the reasons I will be going to dubai, but having said that the cost will go up.but I thank you all for the support.

no grafts to crown at all and No i did not take the picture unfortunately.

sorry it is 2510 grafts not 2501.

This Young gentleman who came to me for HT Undergone a FUT on 15.01.2009 with 2510 grafts. he called me back in september and I saw him, he had apparently very less growth for 7 months post op and I was willing to do a free surgery for him cause I thought the results were about 50%. Though I asked him that we will have one more check up at 11 months time and if the hairs still do not grow then I will do a complimentary as I always do as a consumer protection plan. This is how he was at the end of 11th month with obviously a good results and so we deffered the surgery and he is just one more happy ending. Moral of Story: wait for minimum of 1 Year before you can judge the result.

Its too early for the comments, your most grafts have fallen off and new has yet to come. You are in a stage of telogen effluvium state so wait. Though I can see few things the most important is the directions of the hair growth, all grafts are not going in the same direction and I personally think that this does not help in giving the natural looking hair lines and I believe in naturtalness not density. But I am sure that the results would come out really great and just may be those hair are not in right direction because of the falling effects. So hope for the best and good luck

I have seen his before and after and I think he has good standard results. Just have to see few scar results. Otherwise I think considering the amount of work in India he is a good choice. Best of luck

Dear Forum Members Sorry for such delay but attockbay has apologized and I have no issues with him. I have forgiven his ignorance and I am sure he will be happy with time. Though I assure him that If God forbid he does not get a decent result then I am always there for my patients.

Dear Maxxy As I could not find the pictures I presume that I did not take may be I have forgotten or may be I lost the file in transit from Camera to laptop. But That is why I am not defending the scar at all. Though I thank all of you Mind you he had a full consultation and this was not his first surgrey at all. So he should be knowing it even before but we do make sure that all people especially the in between hair transplant should know about shock loss. But will be careful.

Dear Razi Thank you for support, I can post his pictures if he ask me to do so. The problem is not of bad results or so, the problem is he will complete his 4 months on 28th Nov 2009. We all know that the shock loss will last till 5 months post op. that means till 28th Dec 2009, and only then he will start having to recover his old and new hairs. The hair tend to grow about 1 to 2 cm per month, so by the time he will recover his same length it will be not earlier than March April, so as far as he keeps his patience I am there all the way with him supporting him. But there is a right way of asking things and there is a wrong way of asking things. I am afraid he just do not understand and in spite of telling him time and again. HE HAS TO WAIT ONLY. the time will tell and if the results are not there then I will compensate without him even asking for it. I protect my patients from my own self. Just because they are the consumer and I can profit from some one else, so consumer protection is there. Self Audit.

Dear Friends This Gentleman is a patient of mine who had a hair transplant done in another clinic and had about 5 to 6 mm scar, but unfortunately I did not take the pictures of his previous scar. So I cannot back my words so I will not blame his previous surgery. Having said this, His surgery was done on 28th July and he called me in september/oct that he has a huge scar and send me few pictures. He had 2630 grafts with 1300 of them as single hair grafts and rest as mainly two's. Knowing that he had a previous surgery and as per his honest confession that the previous scar was big but not as big as he see it now (email saved with me) he told me that the surgery is a total failure and I need to give him his money back and also the cost of travelling. I told him all about the shock loss and the minimum time to see any improvement at all is about 4 to 5 months and that we will look after him but he has to wait till April before we can even discuss any issues regarding the failure. He told me in his last email that he will go onto all the forums and threatened me with bad publicity and all he has written. He told me that he will do every thing in his power to hit me hard. Time and again I told him to stay patient and when ever he is back we will look into the matter and sort the things out for him. In his last email, He told me he is coming to Pakistan in December and I need to redo the surgery and I told him that no way I am gonna do anything before the end of april and all he has to do is be patient. he is not ready to listen to anything and is adamant that i need to give him his full refund and also the return ticket cause he travelled all the way from USA. I can be there for him for a complimentary surgery, I can even look into giving him his 100% money back but I am not morally responsible for a travelling refund. Anyway, before he even complain about anything he needs to wait till minimum of April 2010. At the same time I am sure that the forum will discourage people like him to miss use his right of speach to defame some one else who works hard to earn his reputation. We as doctors have to work very hard to achieve a certain level and some one who does not understand the procedure and can just give a bad mouth. I was actually initially even ready to give him partial travelling cost, but since he threatened me with black mailing, I have withdrawn my personal favour to him. As much as I am a soft heart man I feel pride in my work and if some one comes and hurt my pride I do know my rights as well. I would ask the forum, to tell him the importance of patience, the shock loss, the time frame before we can even consider the hair transplant results, the limitation of a second procedure, his age and the fact he had 2630 grafts as a second surgery. Once he understand and I am sure with the time when he will get his results back, which he will, he need to say sorry to me. regards to every one

my mornings are very busy as I do on an average 3 to 4 surgeries a day and then I also do other procedures and hence it becomes physically impossible to keep up with calls that will take 15 to 20 minutes. I assure you my cell is never off just that when I do not answer its because I am with another client and I do not pic phones when I am with some one. I picked yours the other day just because it was from out of country and I thought it was one of my clients and I do not want to ignore my out of country clients and that is why my cell is never switched off. I want to be on the other side of the phone when ever they want me

let me clarify this issue I think giving a tel no on this forum is not allowed and I do not wish to do some thing that can be not allowed or taken in a wrong way just send me a personal message and I will give you my number. I am free to talk Pakistan time between 9 pm and 11 pm.

Dear Faisal Your information as a patient is a bit more than I will give to any of my clients. Its seems almost as if you are a consultant or some one who works for the clinic. I am not sure but thats the impression I am getting from your messages. That is perfectly fine and lot of people who were the clients and have become the paid show case models or the consultants or patient coordinators but disclosure is a must.