arfy

Paco

If you look at the pics supplied by JoeHT (you provided a link to them) he doesn't appear to have gotten a top-notch procedure.

It's not nice to tell guys "wow your HT looks bad" when they are fresh out of surgery, but I bet a lot of guys here were thinking exactly that, about JoeHT (like I was).

I believe that JoeHT has talked about looking for a different doctor, if he needs more procedures.

The important issue here is consistency. Is it consistent and reliable to do megasessions of FUE on every patient?

This question is not going to be answered by judging the results of only a few patients.

As was already stated, Dr. Woods limits his graft numbers, even though he could certainly do more. Over time, he apparently found that it's possible to get diminishing returns. I suspect that he settled on a level that he found consistently good results in all patients. Again, whatever techniques are used must be good for all patients, and if certain patients do not qualify for larger sessions (because of inconsistent growth) then it is important to know that ahead of time.

I hope that no DHI patients have to crash & burn, in order to figure out that there are limits on how many grafts can be done in a short time. The danger here is that if doing huge sessions with unsatisfactory growth, the patient could potentially become donor depleted in just a few days.

Every clinic can produce "some" excellent patients, the trick is to pick the clinics that can do it consistently.

Paco

Have you seen patients of this doctor in person? (And not just the people who might work in his office). Were you impressed with the doctor's patients? Since this doctor is local to you, there should be no problem with seeing plenty of patients.

Dr. Karamikian's website says he likes a "mixed graft" approach and thinks that the 'all-micrograft' approach does not result in enough density. Most of the guys on this forum think the mixed graft approach is not as good as the all-FU procedure (a type of micrograft).

Look at the article Best Hair Transplant to get an explanation of why the all-FU procedure is considered better than mixed grafts.

I know you already said that the doctor would use only Micrografts in your hairline (which is good). All I am trying to say is that this doc may not be one of the best choices out there. So make sure you've seen some patients in person, hopefully guys with similar hair characteristics as you have. Look at these patients carefully, up close and personal, and really examine their results with a critical eye.

By the way, this is what Dr. Karamikian says about megasessions, (which makes me think he may be behind the times):<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>What Are Single-hair Transplants and Megasessions?

Single-hair transplanting is the attempt to once again avoid "plugs" and thereby create a natural result. In this procedure, large numbers of single-hair grafts, sometimes even several thousand, are made from strips of hair removed from one's donor area, and are individually inserted into the top of the scalp. These megasessions can take up to twelve hours each. The benefit of this type of session is that the result looks natural, but as several patients have asked me, "Where's the hair?"

Megasessions usually create a thin result, and often, the patient is fooled into believing that one giant session will solve their whole problem.

The best thing to do is to see as many patients in person as you can, and trust your own eyes.

Paco

Your hair looks pretty normal to me, I don't know why you are getting so much flack from family and friends.

I think you can probably do better than Dr. Karamikian. I'm not even convinced that you need a hair transplant. How old are you? Are you using any preventive medication like Propecia, to keep the hair you still have? Have you seen many of Dr. Karamikian's patients in person, so you have an idea of what you can expect?

To Mel in NY, most top docs say that a single blade is the preferred way to create the donor strip. Like I said, you really can't steer more than one blade at a time.

Some doctors use a double blade, with each blade acting as the 'outside edge' of the strip. The logic is that cutting both edges at once means that you are cutting into taut, virgin scalp. In other words, a single blade will loosen ("un-tether") the scalp after the first incision, making the second incision into a scalp that "gives" more than they prefer. By using a double blade, the scalp remains taut while doing their first incisions. The reasoning is that in a de-tethered scalp, some follicles might get dragged in front of the knife blade during the second pass.

I may not be explaining that very well, but some doctors use a double blade for what they explain as caution. I'm not defending the double blade, the single blade is the preferred method, but a single blade probably takes more time and more care than the double blade. I'm just explaining what is some of the reasoning behind a double blade. If my explanation doesn't make sense, let me know.

Any more than a single blade is really for the convenience of the surgeon and the techs. (3 blades creates 2 smaller strips, 4 blades creates 3 strips, etc). It makes their jobs easier by giving them a jump start on graft dissection, because they are starting out with smaller pieces right off the bat. However, multi-bladed knives waste donor hair, and since every follicle is valuable, this approach should be avoided.

Maybe you can ask Dr. Karamikian how many blades does the scalpel have, that he use for creating the donor strip? Ask if you can see it, and if there is more than one blade, ask him why?

Should be interesting to hear his reasoning...

If you needed a heart transplant, you'd probably fly around the world to see 'the best' surgeon.

A hair transplant should be no different, because (unfortunately) the best hair transplant surgeons are very rare.

Everybody is free to decide who THEY think is 'the best', but I urge guys not to settle for less.

I agree with "Luck", you may need to travel. There's not that many great doctors doing hair transplants, and an "average" transplant isn't worth a damn. It will probably look like an obvious transplant. Seek out a top doctor, or do not get surgery. That may mean going out of town.

I would also recommend that you avoid the big franchises like Bosley, Medical Hair Restoration (MHR) and Nu/Hart. They are not doing the best work available, and they pass the high costs of advertising on to their patients.

My first transplants were done by Carlos Puig, who now does transplants in Houston with MHR. I'm still trying to get his work fixed. I recommend you avoid Dr. Puig like the plague.

Look at the article Best Hair Transplant for some tips on what to look for, and what to avoid. Do yourself a favor and read up on hair transplants, so that you can make an informed decision. It's very easy to make a mistake and do something you'll regret later. Be an informed consumer and protect yourself, because a bad hair transplant is worse than being bald.

It looks like Dr. Karamikian uses a multi-bladed knife for the strip excision. That's not considered top-rung, in the world of strip. How many blades can the doctor steer at the time he is making the donor strip incision? Probably just one. That means that additional blades are probably transecting (cutting) potential hair follicles, possibly damaging them beyond hope.

In short, the multi-bladed knife causes more damage than a single blade. A key in getting good results from a hair transplant is conserving potential donor hair, and maximizing your donor supply. You have a limited donor "bank" and wasting hairs is a cardinal sin, because you may need those hairs in the future. It is a terrible situation to run out of donor supply and still need additional work.

I would still go on your consultation with Dr. Karamikian just to get some experience in meeting with hair transplant doctors, but I would not sign up for anything until you really know the finer points of the procedure, what to look for and what to avoid, etc. Play the field for a while and don't rush into anything.

Dr. Karamikian on CBS, reference to multi-bladed knife

Well you may want to get on Finasteride to prevent further hair loss. Try to keep as much original hair as you possibly can.

Some people advocate using Minoxidil to 'jump start' graft growth. Something to think about...

Rogaine and Hair Transplants

At only four months on Propecia, you need to wait and stay the course with your meds. This is a long-term treatment, and it takes time to see results. Give it a year at least.

The best case scenario is that the meds work for you, and you can avoid hair transplant surgery. You still have a ton of hair, you are young with recent hair loss... you are a prime candidate for those meds and should see results. At a minimum you should be able to keep the hair you still have right now.

A small percentage of guys are non-responders to medication and hopefully you are not a member of that group (although it is way to early to tell). These drugs do not work that well on reversing hairloss, but they usually work very well at stopping (or seriously slowing down) your hair loss.

If you stay the course and are a responder, you will never have to be bald. Other drugs and better treatments are in development too, so keep your head up.

The best candidates for a hair transplant are older guys (30s at least, in my opinion) with more advanced hair loss than you, and a distinct pattern of baldness.

It's possible to get a good HT from a DO, although I would prefer an MD.

On a related note, you may be interested to know that Osteopaths (D.O.s) had "quack-ish" historical origins, when they were established years ago.

Personally, I wouldn't pay a penny for it until I see some independant studies showing it does something.

There is one study that I know of, that people who sell laser therapy always quote. It consisted of approximately 30 people (not enough to be statistically significant) and it was conducted by a guy who operates a clinic that sells the treatment.

This stuff has been available for years, yet there are no independant studies that I know of (correct me if I am wrong though). I take that as a very bad sign.

There is one surgeon I would consider somewhat credible who offers laser therapy to his HT patients, and at least one surgeon I consider very "un" credible who also sells it. One way for doctors to make extra money in the HT business is to offer your patients a lot of additional crap... hair vitamins and shampoos and that sort of junk. In my opinion this laser therapy is additional junk they can sell you, that you don't need. Maybe I'm wrong though.

People who sell the treatment say you can wean yourself off it, eventually. In other words it's a cure. Yeah right!!! Stop the presses!

I would wait for some definitive proof, since you're talking about spending thousands of bucks to sit under one of their hair-dryer type contraptions.

I think there is some evidence that laser light therapy can do something for wound healing. How that translates to hair growth is beyond me. And the people who sell the crap can't explain how it supposedly works either... it "stimulates cell activity" or some vague nonsense like that.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>In the 1990's every hair transplant clinic were stating that with the new mini and micro graphs you now can a full head of hair and a natural hairline compared to the old plug method of the 80's....BUT!!! when mostly everyone had gotten those procedures(mini and micrographs) the results were not so good!!

Just kidding. Nothing has really ever changed. Corrupt clinics were advertising that the big plug tranplants of the 60s, 70s and 80s were "undetectible" and "natural looking" too.

There are still clinics that lie and mislead patients about what they can achieve, today.<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>I know each person varies and should have different expectations based on their personal situation and of course the doctor they choose,but it does make you think twice!! Right on.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR> What makes Cage's HT bad? Please be specific instead of just saying it is bad.

Just because a doctor did a celebrity is no reason to choose that clinic. The doctor who supposedly did "Greg Brady" has damaged a countless number of guys, and is one of the most-hated doctors in the field.

You're right Rocky, at week 5 it may not be a graft. For example it could just be a graft that went dormant, as the timing (5 week mark) would seem to indicate. The graft may still be in his scalp, and may produce new follicles after the dormant phase is over.

However, I think a graft can be lost but still remain in the scalp, until it eventually works itself out after a couple of weeks.

Celebrities have a team of makeup and hair people that work on them before going on camera. Don't think you are looking at a 'real world" result, in many cases they are wearing concealers or even hairpieces.

For example, a lot of people say Nick Cage's HT looks good, when actually they are looking at him wearing a hairpiece. His HT does not look good, unfortunately.

I would only judge a clebrity HT if you saw them in person, in a non-professional setting.

Sometimes in a multi-hair graft, one (or more) of those follicles can be in a dormant phase. That makes it hard for the technician to see that it is a multi-hair FU.

In other words the graft looks like a one-hair FU, but it is really a double.

It's not something that a good doctor would do on purpose. It's an accident. I don't know if there is any way to avoid it.

I would ask Dr. Keene for additional info and ask what she suggests.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>can you have multiple strip procedures using the same scar?

Another approach I've seen recommended is to take a strip from one side, then later from the other side (basically connecting them as much as possible in the middle).

What you don't want is to take strips 'stacked' in a vertical column. You want one scar, that may be long (or short) but not multiple scars one on top of another like this:

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It's not great, but it is not the end of the world probably.

What I've heard is that losing one or two grafts per each 1000 is considered normal.

So losing a graft or two is considered normal, but if you only moved a small number of grafts and a couple were lost, that is above the average.

I would not blow my top over that, if everything else is basically going okay then remain calm.

The transplanted hairs can come in at different times. 5 weeks is still early. Also, the average to see the beginnings of regrowth is 10-12 weeks.

If you are at 6 or 9 months and some areas still have no growth (and body hair was not involved), then you should feel concerned.

Sometimes the recipient area gets covered in blood and it is easy for the clinic to miss grafting into small areas if they aren't careful. Are you certain that those areas did recieve grafts?

Most people think you should give Propecia at least a year (or more) to decide if it is working for you. Whether you should wait (as you asked) really depends on your hair loss, how much work you need done, whether Propecia could possibly satisfy you (if it works for you) etc.

If there is any chance that Propecia can satisfy your goals, then I think you should definitely wait, and not get any surgery at this time. The ideal situation would be that you solve your hair loss issues without getting any surgery! Surgery should be a last resort for you.

As far as the surgery being genuine, look at the article Best Hair Transplant If your doctor does not use microscopes or does not use only Follicular Unit micrografts (read the link) then look elsewhere.

If you want more specific advice, consider posting your photos, and infornmation such as your age, how long you've been losing hair etc. If the doctor has a website, then post a link for the website, so we can see what his approach is.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>they wanted to book me for surgery without seeing me first. That didn't seem right at all. YIKES...Run, Forrest, run!

Minoxidil can be extremely irritating to some guys' scalps. If you have scalp peeling and you are using Minoxidil, that is an obvious factor to consider.

Be careful when considering this surgery, it is permanent and basically there is no way to undo it completely.

Most of the clinics doing hair transplants don't do consistently exellent work. If you get only an 'okay' or average hair transplant, it will probably look like an obvious hair transplant to other people. What good is that? Only an excellent hair transplant will look natural enough to not look like an obvious cosmetic surgery. The whole point of cosmetic surgery is to not look obvious. Unfortunately, the number of truly excellent doctors in the field is very very small, in my opinion.

If you have a bad (or only mediocre) result from your surgery, it can be WORSE than just being bald.

See LOTS of patients of this doctor in person, before deciding on a surgery. Hopefully the guys you meet will have similar characteristics as you (same age, same amount of hair loss, etc). And NOT just the guys the doctor hired to work in his clinic, I mean regular 'outside' patients who do not work for the doctor. Get an idea of what the average patient gets for results.

I agree with everything in FedUp77's post.

The website looks cheesey with lines about "The magic of hair transplantation".

Look at the article called Best Hair Transplant which can be found on the Hair Transplant Network home page. That is a good condensed explanation of the state of the art strip approach. Make sure that if you get a strip excision transplant, that the clinic uses binocular microscopes to dissect the grafts, and that they do not use any larger grafts. You want only Follicular Unit micrografts, that have been microscopically trimmed. If Dr. Gauvin does not use that exact approach, look elsewhere.

By the way, are you (Brando19) only 19 years old? If so, you are almost certainly too young. You should be using medication for your hair loss, and should not get any surgery at that age.

Hair transplants do not prevent future hair loss. If you think you will continue to lose more hair, then you may want to seriously consider Propecia.

If you get a transplant and continue to lose hair, it's like bailing water out of a leaky rowboat.

Since there is a limited amount of donor hair (not enough to restore a full head of hair) you should try to retain as much of your original hair as possible.