Dr. Pak's patient

These websites are scarey, and almost had me stopping the Finasteride 1.25 mg I started only 21 days ago. http://www.askapatient.com/vie...name=PROPECIA&page=2 http://www.propeciasideeffects.com http://www.propeciahelp.com/fo...ic.php?p=14529#14529 http://www.propeciahelp.com/fo...viewtopic.php?t=2002 http://www.topix.com/forum/dru...ar/T0KGFP19QC3CDB54V Today I called Dr. Rassman to discuss it and he relaxed me by saying if after 21 days if I haven't had any symptoms of ED (or anything similar) then I am not in the 2% of men who will experience side effects). In addition to the majority of hids patients taking the drug, Dr. R takes it himself as does his son, and they have not had side effects. My sexual desire and performance has not been impacted whatsoever (certainly it helps that I have a smoking hot 25 year old wife); verified that again today just for peace of mind. However, this subject still has me somewhat nervous. There are entire websites dedicated to discussing side effects of Finasteride, with so many folks posting their awful experiences, it makes one question if indeed only 2% of users suffer from side effects. Many of the folks posting claims the side effect didn't begin for years, and even after they have been off the drug for years the side effects have not subsided. These men claim they live with ED, infertility, decreased sperm count, decreased libido, shrunken and/or deformed penis and/or testicles, enlarged breast, depression, foggy mind with poor memory, inability to articulate as well as they once could, etc... I read some of these sites and questioned if it is worth all of this risk to retain more hair for a longer period of time, or just go natural and get a HT every 5 years (like a new car). For now I am going with Dr. Rassman's expertise, continue with my 1.25 mg of Finsteride, and trust in his professional opinion.

What is PRP, I want to learn more about it?

I appreciate the support, thanks fellas. I'll be sure and update this thread.

Wow, I'm sure 2,644 graft will result in a dense hairline for you. I am impressed with what I've sen of Dr. Rahal's work. Congrats!

Nine days after HT Dr. Rassman's clinical assesment of grafts dislodging after HT when a hair is pulled on is as follows: "When you pass day 5 you generally can not dislodge the graft with simple traction of the hair and even if you can pull the hair out, the graft stays in and is capable of making a new hair." However, pulling on scabs (crusting) is different and grafts can be dislodged up to the ninth day after HT when a scab is pulled. Dr. Rassman and Dr. Berstein conducted a clinical study on this subject with 42 patients participating, using an array of criteria, a truly fascinating read http://www.newhair.com/resourc...-graft-anchoring.pdf Below I am posting on pre-operative, operative, immediate post-operative developments, and general experience to this point. Pre-operative interface Dr. Pak: Excellent, he answered everything in-depth without talking over my head, straight forward approach, very real, no sugar coating with ideals or offering false expectations whatsoever, and he gave me a sense of confidence (indirectly) that I was in very capable hands. Operative interface with Dr. Pak: What I remember was excellent, but I have little recollection therefore I believe I may not have been concious during the majority of the surgery. Post-operative interface Dr. Pak: Excellent. He saw me the day following the surgery. I have paged him twice since the surgery (questions on facial swelling) and both times he called me within 15 minutes. Dr. Pak has been very reassuring. Interface with NHI staff before, during, and after surgery: Office staff was excellent, never pushy, very accomodating and polite. The surgical staff at NHI was top caliber, always technically focused yet they maintained a light sense of humor which immediately put me at ease with them. Pain management: I am a big baby with pain and discomfort, but I had NO real pain, nor do I have any still. I did not even feel a needle pick when Dr. Pak administered the anesthesia. After the surgery I was given Vicodin for pain, Endocet in case of more severe pain, and Valium to help me sleep, but never had a need for any of the above. Impression of hairline design: Excellent, Dr. Pak drew it on the day before, we discussed options and what I wanted, and he modified it accordingly. The day of the surgery he drew it on, I commented and he slightly modified it. I am optimistic it will yield a satisfactory result (even with me being a self-consumed neurotic perfectionist). Aftercare: I've read Dr. Rassmans papers and posts on aftercare, and followed Dr. Pak's advice religeously. The morning after the surgery I had my head washed clean at NHI. For the first 7 days I washed my head every 12 hours using Graftcyte shampoo (which NHI gave me), by soaking the donor area with direct water for 10 minutes and gently lathering, while still keeping the recipient area dry. Then for the last 5 minutes I would very gently apply shampoo and suds to the recipient area and rinse immediately with indirect water. After each shower I have my wife apply the Bacitracin Zinc Ointment that NHI gave me lightly and thin across the incision/scar. On the 8th day I switched to showering once a day, and have begun a gentle message of the recipient area which is removing the crusting. Crusting: For the first week I had significant crusting all over the recipient area. Notice in today's photo above at nine days, that nearly all crusting at recipient area is gone. I was a little self conscious going to work, but my wife, family, and a friend all said it wasn't noicable because the little hair I have in the recipient area worked very well as camoflage, and honestly not one person noticed. I feel like I've had no 'ugly duckling' stage. Facial swelling: This began exactly 3 days after the HT, it was pretty bad but my eyes were not swollen shut. I took Advil, Naproxen, and an antibotic for dental infection but it did not go back down for two days. It was for this reason alone that I had to call in sick to work, but I returned to work on the 6th day after the procedure looking perfectly fine. Scalp tightness: Very tight, and this not comfortable and makes me a little nervous. I don't want to accidentally strech the incision and cause a wider scar. Taking a 15 hot shower seens to sooth and relax the tightnes of the donor area. I will not return to the gym until January 1st which will be 21 days after the surgery, and still will not be doing my crunches with hands behind my neck for 2 to 3 months for fear of stretching the incision/scar. Scalp tenderness: The donor area is not too tender to touch by bluntly covering the entire area with my hand. However, if my donor area is contacted in a single point, like touching the headrest while I'm driving, then it is very tender. I'm not real happy with this tenderness and hope it will subside soon, as part of my job entails regular visits to a large construction site with a hard hat on for extended periods of time. Scalp numbness: It feels partially numb still in both donor and recipient areas, I can't wait until my old scalp feeling returns to normal. Iching: It has not been all that ichy in the donor area. The recipient area has had minor iching and Dr. Pak advised that I can lightly tap it but no more, this seemed to work alright. Itching has not been a real concern for me. Shock loss: I have experienced very minor shock loss, approximately 30 hairs, directly adjacent to the donor incision in two tiny spots. I have not detected any shock loss of hair at the recipient area. No real concern with shock loss thus far. General: Although it is way to early to tell still what the results will be, I won't know really until about September, I do have a high degree of confidence and believe my procedure to be about as good as it gets with the technology available today. I am counting on Finasteride to work for my vertex, filling in the minor loss at the crown, and help me to maintain the hair I currently have as long as possible. I hope not to need another procedure for sometime, and when that time comes I hope that hair cloning is widely in practice. I'm also contemplating starting to take hair thickening supplements, but I am not sure which yet...as always suggestions and experience feedback is much appreciated.

Congrats, I think your results are really great, and I can't wait until my hairline comes in like that! Had my first HT last week, was +/- around the same balding level you were before the surgery, and I had 2,431 grafts in total.

Thank you guys, your posts on the hairline design and post-op pics are very encouraging, and something that is rather soothing to hear right now. Apparently my surgery went easy as compared to other stories I've read. I believe I was unconscious over 50% of the time, fading in/out, at least I don't remember the majority. I've had virtually no pain. Other than the medication(s) provided me for pain during the day of the procedure, I have had only some discomfort but no need for pain management pills following post-op phase. I've had no bleeding after the day of surgery, and the healing has begun, I know this because itching started today and for me that is the normal healing sign. Now that 3 days have passed, I am starting to see some facial swelling...bags under my eyes. I called Dr. Pak's cell number and in 10 minutes he called back to remind me that we went over all of that...not to worry tomorrow the swelling should go down. I should also report that Dr. Pak has an excellent beside manner, he connected very well with me, his surgical staff (5 or 6 techs) I took as being very professionally focused and polite, and NHI's services in general I found to be top quality and accomodating. I have been carefully following all of the post-op instructions provided by NHI, and will stay away from the gym until after the New Year. I am so looking forward to watching my hair line grow back in this summer...wow, can't hardly wait! I'd like to again express my graditude for the support from this community and the great advice, most of all for getting across your conviction that I needed to significantly increase the number of grafts. Time will tell all, but I have a good feeling about my procedure, the results should follow in suit, and I'll definately post my progress photos here.

THANKS 2,431 GRAFTS (#1 = 970, #2 = 1,398, #3 = 63, TOTAL HAIRS = 3,955)

These photographs were taken on the day of my surgery; 12/10/09. HAIR LINE DESIGN THE FRONT, 2,431 GRAFTS (#1 = 970, #2 = 1,398, #3 = 63, TOTAL HAIRS = 3,955) RIGHT SIDE LEFT SIDE DONOR AREA

Phil I'm curious as to why it matter which one, is it that you don't believe that a doctor on this site would cite those numbers to me? I even went as far as decribing everything I heard on this forum...did my best to pushing for him to move up from 1,800 - 2,000 but he was not inclined to budge. I'll tell y'all later if that is OK with you, seems like opinions are very rigid now and I don't know how this doctor would appreciate backlash. No conspiracy, I just wanted to know who it is. If a doctor on this site gave an estimate and stands by it I don't see why he would care if people knew that. Doctors do consultations all the time and they gets discussed here. Since you said your surgery is this week I just want to wish you good luck and I hope you get a great result. Please keep us updated. Phil it was Dr. Ken Siporin.

Phil - Thanks for the well wishes. Bill - Not sure...I may have unitentionally offended you in some way, if so much appologies. I just posted my understanding of this subject, but may have got off topic, or in this case may have posted a misunderstanding. I assure you all I have no agenda, have nothing to gain from promoting any doctor, and most of all honestly meant no disrespect to anyone or this site.

Other than Dr. Shapiro, which clinics are you refering to?

Phil I'm curious as to why it matter which one, is it that you don't believe that a doctor on this site would cite those numbers to me? I even went as far as decribing everything I heard on this forum...did my best to pushing for him to move up from 1,800 - 2,000 but he was not inclined to budge. I'll tell y'all later if that is OK with you, seems like opinions are very rigid now and I don't know how this doctor would appreciate backlash.

It was not mentioned as part of the "screening" criteria, but apparently yes they do, and I understand it's quite expensive. This fact adds a whole new dimension to my perspective of this site...I guess I am pretty nieve because honestly I am somewhat shocked by this revelation.

1. That would mean 3,000 to 3,500 grafts. I respect the opinions of people here, y'all certainly know better than me, but the medical practices and doctors I've consulted all say that high of a number sounds to them like a whole lot more grafts than I need. 2. Deposit was only $1K and Dr.Pak offered it all back to me. After I asked that he read through this thread he replied if your not comfortable I'll refund 100% of your deposit, but I turned him down...I am comfortable with him; no reason not to be. To be perfectly frank, Dr. Pak was solicited by this site at one time but decided he was not going to pay the high monthly fees associated with being endorsed here. For whatever reason Dr. Rassman maintains his membership, I can imagine it's because of perceptions and the business it brings him. 3. In the last 24 hours I have consulted with another highly surgeon recommend by this website. After reviewing my same three photos (including the target photo) he too recommend 1,800 to 2,000 grafts. He also said he achieves a 90% survial rate on the average and paks approximately 50 grafts per square centimeter, but up to 90 grafts is possible. Lastly he said if I wanted a second procedure to achieve higher density that would most likely be the way to achieve the result I am seeking. This surgeon quoted me at $7,500 for 2,000 grafts which works out to $3.75 each. This works out to about exactly the same as I'm paying now because NHI is reimbursing 100% of travel expenses (flights, rental car, taxi).

I conceed up front that I'm not a seasoned critic like some of you, therefore my opinion may change over time, but my current understanding of that thread as it applies to my situation is as follows. This NHI patient was catagorized as a Norwood "3A evolving into a 4A pattern" which would indicate a little more hairloss loss than what I have now; I am a 2A evolving into a 3A. It looks like a good end result with a natural looking straight and full hairline. However 3,790 is more grafts than I would had thought would be required. NHI did two of his procedures totaling 2,375 of those grafts, and another clinic(s) previously did the initial 1,415. In my opinion four procedures is absurd in order to achieve this end result, only if he was a 5+ or if the first couple went bad could I understand having this many procedures. As I posted earlier, I want only one procedure and Finasteride should do the rest, but MAYBE in the future will need a second procedures to achieve this level of density, I am now more accepting of this possibility and we'll have to see. I have some advantages going for me that this patient did not, first my scalp is a clean canvas with no previous failed HT to repair, or scar issues, healing issues etc, and I have less realestate to cover. I'm looking forward to meeting Dr. Pak Thursday, and remain optimistic with my upcoming HT; I will keep this thread posted with developments.

Wow, just fascinated by the technical info, please keep stuffing my brain...you guys are the cat's meow. I have a call into NHI for Dr. Pak and/or Rassman to address some more specific questions, one of which will be what is the maximum number of grafts per square centimeter that they've achieved sucessfully, and what was the survival rate associated to that procedure. Thanks!

The point you guys raise about numbers of the grafts required to reach the maximum capacity of density I seek is very well taken. I agree that I had underestimated initially. The 1,500 to 1,800 grafts number provided to me by to other HT clinics that I had visited (not NHI) was too low. When I called Dr. Pak and gave him these figures with photos he said a final assesment would be done in person with him, and that 1,800 may not achieve the density I have targeted (December 2000 photo). I was clutching at my wallet (not wanting to be broke), but you've convinced me that with 1,800 I am far away from the desired results and as a result I am prepared to move up to 2,500 grafts. How did I come to this number you ask? Well this site also gave that to me using an awesome tool, go here http://www.hairtransplantnetwork.com/MM-center.asp and scroll down then click on "calculate number of grafts needed, after the pop-up click on skip intro. Now select only Areas 1, 2, and 3 (the three areas I am currently targeting for restoration), move the the number of grafts per square centimeter bar hard right to 45 square centimeters, and click calculate. The response given is 3,100 grafts and 6,610 hairs needed in total. This is taking a person who is bald in these locations, which I am not in Area 3, my Area 3 is thinning but a significant amount of hair is still present there. I conclude that 2,500 (+ a few extras possibly) will restore my Areas 1, 2, and 3 to a very full appearance.

Phil you are correct that I have not met many HT patients, I'd say 5 at most, but my close friend has hairline work from Dr. Rassman (1997), his hairline was not at all far from where mine is now and that was done quite well with only 1,300, however he and I will both conceed that only having received 1,300 grafts at that time he is now contemplating having a second procedure at NHI. Dr. Pak did not say to me that 1,800 would achieve the density level I seek and expect, in fact he said the hairline goal will be met but to expect the density goal as my 2000 December pic would be less than what I want. This forum has driven that point home, I am very grateful for that, so I have bumped up my HT to a minimum of 2,200 and a maximum of 2,500 grafts. Should I need a second procedure in the future so be it...my perspective is as long as the first is done by a world class hair restoration surgeon to the best of his ability on a good day I should be pleased.

I'm sure your correct in that he has yet to be screened here, but not only has he worked directly under Dr. Rassman since 1997 doing nothing but HT, Dr. Rassman has stated that Dr. Pak's talents equal his own, now surely this has to hold significant weight. I have visted the websites of +/- 10 doctor's on this forum so far, some showing some super good work and others not so much. So just because a doctor is endorsed here does not give them an automatic 5 star rating in my book. On the other hand, I do find the 'screening' and standards of those on this site to be exceptional in general. It's truly is an awesome thing to have so many seasoned critics residing in one place...I am impressed with the level of scrutiny found here.

Than - I'm thinking your post is with the best intentions, and for that I'm grateful, however my perspective differs from yours. I may be moving quickly having only considered three medical practices, but I do have confidence in Dr. Rassman's assurance that Dr. Pak is every bit as good as he is (without the infamy). In HT there are many opinions and no assurances, so I don't believe that folks here can state definitively that Doctors Shapiro, Bernstein, Reed etc are better suited to yield any better results than Dr. Rassman or Dr. Pak. In my opinion we are talking world class hair restoration surgeons here...this would be like saying Lamboghini is surely better than Ferrari, da Vinci's works far in a way superior to Rembrandt and Michael Angelo, and that the music composed by Bach, Vivaldi, and Mozart can't hold a candle to Beethoven's. You are correct that I have very high standards, Dr.Pak will know this going in and must strive to satisfy those expectation to the very best of his ability. The photo really makes my hair loss apear worse than it is, the lense and flash was about 12" away from my scalp. Honestly I do not believe that a "receipe for disaster" is whats brewing here, and if my HT done correctly, 2,300 to 2,500 grafts can achieve the result of great hairline with packed density for my condition. Not saying that I won't need another procedure again in the future, I do understand that might, but with any luck that will be far off. If Dr. Pak concentrates his artistIC talents, and carefully oversees that the quality of his staff's work is right on that day I SHOULD be satisfied with the results come next August, and I have faith he will do this; otherwise I would not expose myself to this surgery.

Aaron I encourage you to read Dr. Rassman's reply to an inquiry on this exact subject prior to drawing such a conclusion (prematurely), please post again after going here http://www.baldingblog.com/200...+Loss+Information%29 Thanks

PHIL - Your statement of "definitely at least 3000 and most likely 3500-4500" is a little scary...I don't believe this to be accurate; of course I may be wrong. THAN - Although I appreciate the suggestions to help make this more feasable, I will not be traveling overseas to receive my HT, for many reasons, but thanks nonetheless. AARON - Your statement of "NHI is far and away the most expensive clinic recommended on this site" does not reflect the findings of my research. I called Dr. Shapiro's office (your doctor) and was quoted $5/graft or $4.5/graft standby rate. Dr. Pak is offering my HT at $4/graft for the first 2,500 and $2.5 for each additional graft. You are right about my diving in, I am moving very quickly, all I can say is that I am very much into doing the procedure now. Bill - I understand that Dr. Pak has an excellent track record, and has performed on numerous high profile individuals in the entertainment industry, this along with the full endorsement of Dr. Rassman helps to give me a sense of confidence in his abilities. I just purchased the generic Finasteride 5m which cost me $5 per month from Costco (without insurance), I just have to cut the little pill into quarters and take 1/4 pill per day to achieve a +/- 1.25 mg dose. Propecia is the Merck & Co name brand for this drug already in the form of a 1 mg dose (no need to cut the pill), but it costs about $80 per month. I once tried Rogaine but quickly realized topical applications are not good for me, as I can't be in front of the mirror very long and my scalp is sensative; Rogaine is also expensive. I am banking on Finasteride filling in my crown and do not have immediate plans for grafts in that area. VENTU - I believe your estimate of my needing "3500 - 4000 grafts" is somewhat overkill, however I do find your post helpful. I know I have high expectations, but due to my being a "neurotic, self-obsessed," perfectionist by nature I can't help it, and just can't see myself settling for any less. I pray that I am not left disappointed...we'll have wait to see what Dr. Pak's capabilities and limitations are given the amount of grafts I can afford. BTW my wife took those pics. SPARKY - I sure hope that your post is right on target my man. This HT is all I'm asking from Santa this year and I've behaved exceptionally good. Your feedback is much appreciated gentlemen, the more brutally honest the better (I'm thick skulled), please keep it coming!

Hmmm...you guys got me thinking I need to scrape out the piggy bank. Not real sure how much more I can swing but I'll likely be maximizing now. So I'm guessing 2200 will be my minimum, but I'll try to exceed as much as possible; maybe 2,500. Thanks fellas!

Wow, so you really think I need 2,800 to satisfy my target restoration goal? That would mean another $4K that I simply don't have, unfortunately, but maybe a couple of hunderd more is feasable...an even 2,200 grafts is as far as I can stretch the HT funds. Thank you for your feedback, I will certainly take this into consideration.