arfy

Interesting article. I've heard that bootleggers are able to copy the packaging of the real drugs, making it hard or impossible for the average guy to spot a problem. So there is something to be said for getting your meds from a local pharmacy, if you can afford it.

Membership in the ABHRS is not a guarantee of quality, and not being an ABHRS member is not necessarily a bad sign. In other words, belonging to the ABHRS doesn't mean a whole lot either way. The ABHRS has some good doctors, as well as some doctors I would stay away from. I don't know too much about Dr. Tessler, but I wouldn't pay any attention to whether he has an ABHRS membership. It doesn't mean a thing when it comes to getting good results.

I think if Propecia does actually diminish in effectiveness, it will be a very subtle and gradual change. You're probably not going to notice anthing drastic. You may not even notice at all. It should still accomplish your long-term goals if you responded to begin with.

Good answer Pat! There should be accountability and repercussions for doing sub-standard work.

PAI is a franchise and I would recommend not picking a franchise. Look for a clinic that has a lot of experience doing the all-FU transplant (NO minigrafts). Go to the Best_hair_transplant_procedure page, and even think about printing it out and asking your PAI clinic if that is the exact procedure they use... I can almost guarantee you the answer is NO. Look for a clinic that has several years of experience using microscopically dissected FU grafts only. Then try to meet as many of their patients as possible, and examine them closely. Try to meet with guys who are similar to you... age, type of hair charecteristics, amount of hair loss etc. In my opinion the average hair transplant looks like an obvious hair transplant, and isn't worth a damn. Look for the great clinics or don't do it at all. When I think about which doctors can actually do a great job with transplants, PAI isn't even on my radar screen.

To Kez Bosley and other big franchises do not use microscopes to dissect the donor strip (hopefully this will change). It costs money to invest in the equipment and to train the staff, who have usually been doing their work without microscopes and don't want to change if they don't have to. Microscopes are more precise and so they are more time consuming. Time consuming = less patients and less profits. The all FU procedure IS more difficult and more time consuming than a mixed graft procedure that franchise clinics do. Inexperienced clinics can get poor results with an all-FU procedure if they don't know exactly what they are doing, or haven't gotten the knack. FU grafts are more fragile and are easily damaged, dry out faster, etc. So the clinics who want to switch to an all-FU procedure have to spend money on equipment and training, they lose money by slowing down the process, and there is a chance they will get poor yields until they build up more experience. There is a learning curve to the all-FU transplant, it is harder to do than using larger grafts. These are some of the reasons big franchises do not update their procedure to an all-FU approach. The patient may not realize that he has gotten an average looking transplant. Microscopes can allegedly increase graft yields by a reported 20 to 30 percent. There is no way that a patient can know that some of his grafts were wasted unnecessarily. Lets say a patient goes to a franchise and maxes out his donor area with a total of 6000 grafts, over a couple of surgeries. How is the patient to know that he actually had enough donor hair for 7000 grafts, but his clinic wasted some of his hair? It's impossible for the patient to know... only the techs might know the truth about that... maybe. Also, the franchises like Bosley put Micrografts in the hairline (similar to FUs) but put larger grafts behind that. The patient can ususally only get the clearest possible view of his own hairline, we don't have eyes in the backs of our heads. The Bosley (and other big franchises) philosophy is that only the hairline needs to look completely natural. In my opinion the WHOLE HEAD needs to look natural. Larger grafts do not look natural, but the idea behind mixed grafts is that most people will not notice... unless it is windy, rainy, someone is examining your hair etc. I think some Bosley patients are probably well-enough satisfied with their transplants, but these patients would be surprised to learn that they could have gotten a better hair transplant that would still look good in the rain, in the wind, when being combed through by a barber etc.. the all-FU transplant. Unfortunately the big clinics like Bosley and MHR have not kept up with the times. [This message was edited by arfy on December 18, 2003 at 06:36 PM.]

No, it's not true. In a controlled study, after 5 years, patients who used Propecia had maintained their hair count. If Propecia had stopped working they would have lost hair. The non-propecia patients continued to lose hair. There are some people who think that Propecia may gradually become less effective over a long period of time... that's a lot different than Propecia "stopped" working. http://www.ishrs.org/sciarticle.html If Propecia does gradually lose some effectiveness over time, I don't think that is any reason not to use it. It's still a whole lot better than doing nothing at all, in my opinion.<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>At the end of the fifth year, 65 percent of men taking Propecia (n=219) maintained or improved their hair count compared to their hair count at the start of the studies, while all of the men on placebo (n=15) lost hair count.

A guy is not a Norwood 5 if there is any kind of bridge between the 2 sides, which you still have...

Isn't it a shampoo? If so, don't expect it to help prevent hair loss. If it makes your hair feel nice and isn't too expensive, then what the hell. But don't expect it to help with hair loss.

I personally would recommend getting a legit prescription from your doctor, and getting your Propecia from a local pharmacy. There is a big market for counterfeit drugs and there is no way to tell the bogus stuff without having it analyzed. I'm not trying to scare you but there is a market for bootlegs, and it really doesn't get talked about at all here. I don't know if it is a real risk or not but it is something to consider. I think guys look to online drugs maybe too often. Any reason you wouldn't get a prescription? I personally take Proscar that I get online, but I am twice your age and twice as bald as you are. I have no illusions of regrowing any hair, I am just trying to hang on to the little I have left. If I was a young guy just starting out, I would give serious thought to doing everything by the book, and using drugs that were guaranteed. I don't know, maybe some of these sites DO guarantee their drugs, I do not shop around and look at a lot of different sources. The only reason to order off the net is to get generic versions, in my opinion. Only do that if money is a limiting factor. It can be good to do this under a doctor's supervision, especially in the beginning, just so you can have someone to talk to, besides the other guys on the internet. There's no reason you can't use Minoxidil too, but it's a topical and is a little less convenient. The ideal scenario is you use something simple and it works, end of story. Using multiple treatments can get expensive, it can get inconvenient, and you don't know what works or doesn't work so you have to keep using everything. Using Minoxidil combined with Propecia is supposed to be even more effective than using either alone. But if you can start simple and stay simple that is better. Add Minoxidil if you think you really need serious help. The downside is that you are not supposed to stop using Minoxidil on and off, it makes a bit of a mess of your hair, it can be irritating to your scalp, and is another expense. Also, you might want to add new things gradually, there is a chance that these medications can trigger a shed phase. On the positive side, shedding means that something is working, on the negative side you are losing hair and that is scary. If you still have most of your hair, I would just start with Propecia. Give it a year, take some before and after pics and compare. I think you should do some in-depth research into all these things and also consult a dermatologist or your family doctor. Don't take my word on this stuff... you have to do your own research, learn what the complications and risks can be, and then make your own informed decision. The last thing i want is be responsible for your hair... What about talking to Dr. McAndrews?

Try www.hairtransplantadviser.org and www.hairtransplantguide.com for general info on hair transplants. I don't know what FUI is. There is FUE- follicular unit extraction. Moves grafts one by one, no donor strip. There is FUT - follicular unit transplantation. This uses a donor strip. The websites I mentioned are good for basic introductory info about transplants, but don't have much information on FUE. Get a handle on the basics (for example "what is a FU") if you don't already know for sure. I heard that it takes about 150 FU grafts to recreate an eyebrow. Will putting a couple of eyebrows worth of hair up there really make a difference in your life? Enough to undergo surgery? I personally think the guys who get transplants to try to perfect their hair are making a mistake. Hair transplants are best left to the guys with more than just a trivial amount of hair loss. Don't get any surgery unless it is really necessary. That's my opinion. You haven't mentioned your age. And are you doing anything to prevent your hair loss from getting worse?

If Propecia didn't work for you, you might try Avodart. If you don't stop the progression somehow, then logically you are going to be Norwood7 someday. Make sure you distinguish between Propecia not working (regrowing hair) or not working (stopping or slowing the progression). If anything stops or slow the progression, it is worth using. Otherwise you are in a hair loss free-fall. As far as age, it is really a combination of age/amount of hair loss/expectations. If you still ahve a decent amount of hair and are young, then you shouldn't get a hair transplant. If you are young and already pretty bald (Norwood 4 at least) then you may be an okay candidate if you have low expectations about what it's going to accomplish. Most young guys think a hair transplant is going to restore all their hair (it's not). Young guys are also usually not satisfied with their results as often as an older guy is. This is a complicated question, but in general the younger guys do not make as good a candidate as a guy in his 30s or 40s. You probably still have a lot of hair. The surgery can actually accelerate your hair loss ("shock loss"). You will have to be satisfied with a hairline that is more suited for an older guy, and I bet that's what you already have. There are some doctors who are willing to operate on young guys, usually they are quacks so be careful. At age 24 you are not as young as some other guys, but you are still borderline too young in my opinion. Do yourself a favor and spend a lot of time researching hair transplants, what the pros and cons are, what are the limitations and drawbacks, etc before you decide you want one. There are a lot of misconceptions about hair transplants. They are not the magic bullet for hair loss. Be careful because there are a lot of sharks in the waters, many doctors do not do such a great job of it and only care about your money. You'll have no problem finding someone to operate on you. Whether or not it's actually a good decision for you, is a whole different story though.

Well, I looked at the Kevis site and I'm not too impressed, but if you think it is worth the money based on your experience, then keep using it.

Propecia may not regrow hair in the front, but it should help you KEEP the hair you still have... in the front, back, everywhere. Nothing out there really works all that great at regrowing hair. It's a lot easier to keep the hair you still have. Also, it seems that the more recent your hair loss is, the better you will respond. Since you are only 20, you should have a good chance of seeing some results, maybe even a little bit of regrowth if you are lucky. Avodart is stronger than Propecia and it is new on the market. It stays in your system longer. It doesn't have Propecia's track record yet. Unless there is some reason to take Avodart (for example if Propecia didn't work for you, or you are allergic to Propecia) I don't see any reason to take Avodart. A year from now Avodart will have more of a track record and we will know more. But in the meantime just get started with Propecia. Avodart isn't even available for hair loss yet, you have to talk a doctor into prescribing it. It's also more expensive than Propecia. Don't make it any more complicated than you need to, just get started on Propecia, that is my suggestion. Same thing goes for Minoxidil... start with the simplest regimine first. A year from now, if you want to add Minoxidil because you aren't satisfied with your results, then think about adding it. A guy in your position will probably appreciate startng the simplest and most convenient routine possible. Don't add a lot of other stuff unless it is really necessary. I forget what kevis is but I am pretty sure it's junk... because most treatments are junk. Nothing else is as effective as Propecia. It may not be perfect but Propecia is the best available treatment at this time.

Well, you have a cooler nickname...

Every doctor is priced different. The amount of grafts you are talking about is trivial. If you only have a trivial amount of hair loss, I strongly suggest that you don't get a hair transplant.

The first thing you need to do is try to stop your hair loss from progressing. Think about getting on Propecia, which according to Merck will help over 80% of the guys who use it. Even if you get a transplant, you will still need to try to stop the progression, so that is your first priority... stop the progression. See, there is not enough donor hair to just let everything fall out, and then expect to replace it with transplants. The more hair you can retain, the better off you will be. A hair transplant pretty much never looks as good as having your original hair. If you go see a hair transplant doctor for a visist, go with the purpose of asking about Propecia. You are too young and not bald enough to get a transplant yet. If you can stop your hair loss, you will hopefully never be bald enough to need a hair transplant. Anybody who is willing to do a hair transplant on you at your age, before you have even tried Propecia, with your early stage of hair loss, is probably a quack. You might want to see Paul McAndrews, he fits the description you gave (established, not aggressive, concerned about young people, not a big self-promoter). He teaches at USC (I think) and seems like a good guy.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>the so called dr. said what is red to one person may not be red to another. BRILLIANT!!! To Stephen Sargant, as long as you are 1-2 weeks post op, you should not have to worry about losing a graft. Obviously you should not get excessively rough with your scalp though.

FUE is where they move single grafts one-by-one. I don't think Dr. Tessler does that yet, he uses the donor strip method. You probably mean FU not FUE. No big deal, I'm just trying to avoid confusion. It's hard to keep the acronyms sorted out, sometimes, for me too.

There is a lot of information on the web about suing your doctor or clinic, you just have to look around. Do searches on topics like "quacks", "medical malpractice lawsuit" etc. Don't limit your search to only lawsuits against hair transplant doctors The consent form you signed doesn't let the clinic off the hook for bad behavior. It doesn't give the clinic permission to break the law, or mislead you, or fall short on their promises. And if you see the legal consent form for the first time on the day of your surgery, it may even be considered worthless in court. Nobody can be expected to actually study and understand a legal document only a few minutes before an operation, unless you are undergoing emergency surgery. So the legal waiver you signed might actually be worthless. It might be hard to sue for malpractice, if your complaint is only that you got an average or generic looking result. You need more than "I wish I picked a better doctor" to file a lawsuit. If you have problem donor scarring, for example, that would be a different story. Most clinics don't seem to tell the "whole truth" during your consultation, they just tell you the pros and leave the cons out. That is not obtaining "informed consent" for surgery, if you were not really informed of possible complications. I read that one out of every fifty patients will have an unacceptable donor scar with strip surgery, no matter how perfect the surgery goes. That is lot of guys who will have a problem donor scar. Unless your clinic told you that this was a possibility (and not just signing a consent form, but telling you about the one-in-fifty odds) you may have a case, and should discuss this with a lawyer. There are other angles to pursue with a lawsuit. For example, illegal sales tactics. It is a common practice to have a salesman ("consultant") examine you, and suggest a number of grafts. In some cases they prescribe a number of grafts or a number of surgeries. Sometimes they schedule your surgery without you even meeting the doctor first. All of these things are illegal. It's called the practice of medicine by a non-physician. Your consultant is just a salesman, he has no medical training, and he has no business examining you or making a diagnosis. All the consultant is legally allowed to do is show you pictures of patients, explain what a transplant is, and that type of thing. Not play doctor. But it is common for these salesmen to break the law. Then there is the issue of false claims, false advertising, etc. The TV commercial for Bosley shows individual hairs "magically" flying one-by-one from the back of the head to the front, where it forms a dense bushy full head of hair. (I'm talking about a slick 3D animation here). Obviously that is not how hair transplants work, and Bosley is misrepresenting the surgery. Unless Bosley has been doing FUE, hairs do not get moved one by one... instead, there is a donor strip that gets surgically excised with a scalpel, the donor strip is divided up, the resulting gap is sutured together, etc. It's actual surgery. The only reason to portray this fake version of how hair transplants work is to fool people and create phony impressions about how hair transplants work. This is just one example of false advertising, and you need to think about what you were told by the clinic. Save every booklet, brochure, letter, for your legal files. A lot of times, the clinic tells an unsatisfied patient that the dissatisfaction is based on the patient having "unrealistic expectations". However, it is the responsibility of the clinic, to make sure that the patient has realistic expectations! If the patient has unrealistic expectations, that means the clinic failed to perform it's duties in fully explaining the possible complications, the limitations, etc. Ask your doctor to put any grand claims down in writing, before going ahead with surgery. Does your doctor claim that he "doesn't have any dissatisfied patients", or does he claim that shock loss isn't a risk for you, or that your donor scar will be pencil thin? Ask him to put it in writing. Remember that the statute of limitations for malpractice lawsuits is short... only one or two years before it expires, depending on the state you live in. In some states, the clock starts from the time you actually discovered the problem, not the date of surgery. Look around for a good "med-mal" attorney, or someone who knows about medical fraud, and see what kind of case you have. Here's a directory of med-mal attorneys, this is just one list, there are other such lists on the internet: http://www.medmallawyershop.com/ Here's a FAQ page for basic info on medical malpractice lawsuits (frequently asked questions): http://www.medmalusa.us/general.htm Lawsuits are probably the most effective way to get some satisfaction over a bad hair transplant experience. You can (and probably should) complain to the state medical board, but don't expect too much... the board is made up of other doctors. They will tend to sympathize and align themselves with the clinic. However, I think it is good to have a complaint on file, even if it goes nowhere. How to Complain to your State Medical Board The suggestion to show up at your clinic is a good one. I have heard some of the all-time worst doctors brag that they have never had patients complain. By all means, schedule a follow-up consultation, and give your doctor an ear-full. Don't let your doctor pretend he had no idea you are unhappy. If you think a full refund is warranted, that would be a good time to request it. Make your dissatisfaction known, up close and personal. It is very possible that your doctor will dismiss your complaints ("I think you look great!") and will give you the brush-off. It is next to impossible to get a doctor to admit he made a mistake. And if your dissatisfaction is with a clinic's salesman, you can bet that your problem is a result of the clinic's total lack of regard for your well-being, instead of an "honest mistake". Some clinics run their business like a con game, and they know exactly what they are doing. Maybe you should discuss your concerns with the guys who are in the waiting room, or as people enter the building. If you missed your statute of limitations deadline, there are other options. Be creative. Maybe make a website that details your experience. It is important for guys to hear about the success stories, but also the disappointments and ripoffs too. As far as the Better Business Bureau, they do not handle medical disputes that involve an incompetetnt doctor or botched surgery. They only discuss billing disputes, as far as medical claims. So the BBB is a place to turn, if a clinic won't return your deposit on a surgery you cancelled. You can also contact the attorney general and/or states attorney, and ask them to investigate, or even start a class-action lawsuit. I believe this is what is happening with Bosley... they are the subject of multiple class-action lawsuits, if I am not mistaken. You can complain to the FTC, if there was deceptive advertising involved. The FTC deals with false advertising and that type of thing. The FTC actually threatened to audit the hair transplant industry in the mid-90s, but somehow the doctors fast-talked their way out of it. The point is that the FTC already knows there is illegal and unethical business practices in the hair transplant industry. So your complaint will not be a total surprise at the FTC: FTC complaint form Some guys might be nervous about leaving their name and phone number on a complaint form. If you don't put your name down, it may hurt your chances to be taken seriously. These people are bureucrats, they are not about violating your privacy. So don't be afraid to put down your real contact info, in case the agency wants to do some follow up. In the case of the FTC, state's attorney, etc, these people know nothing about hair transplants, what an FU is, etc. Try to present your complaint in a clear and concise way. Don't use hostile language or insults, keep it professional. Here's something interesting: Did your clinic show you nothing but great-looking photos, when you were at your consultation? In some states that might be considered an "implied guarantee" of success, because it led you to expect those same results for yourself. If you were led to expect excellence and didn't get what you were sold on, there might be the basis of a lawsuit there... They did not fulfill their implied guarantee. Did you end up with a bad donor scar? If so, did your clinic warn you that one in every 50 guys will have a bad donor scar even if the surgery is done perfectly? Obviously this is a topic that is near and dear to my heart. I am in the middle of researching the various options. If you are dissatisfied with your hair transplant, you can contact me at hairtransplantdisaster@hotmail.com I am putting together a web site that discusses problems with hair transplants, false advertising, legal options for patients, and other issues. I would be like to hear from -people who are dissatisfied with their hair transplant -people who have taken legal action (or other action) -anybody who has examples of false advertising by a hair transplant clinic. This could be from any year, recently or from the distant past. Maybe you work at a hair transplant clinic, and you have internal memos or documents that discuss things like sales quotas, or other illegal or unethical practices. I would really like to hear from you, too. Any correspondance is totally 100% confidential. [This message was edited by arfy on December 10, 2003 at 05:08 AM.]

I don't know how many doctors actually read this forum. If they do, I hope they will take 2 minutes to read this article in Dermatology Times, about "how to stay happy in medicine". A Life's Lesson Worth Sharing

I don't know how many doctors actually read this forum. If they do, I hope they will take 2 minutes to read this article in Dermatology Times, about "how to stay happy in medicine". A Life's Lesson Worth Sharing

Hi Matt Nobody wants Bosley to get complaints, have unsatisfied clients or be in trouble. I am somebody who had really bad results with my clinic (Cleveland Hair Clinic- Dr. Puig). Having a problem with a hair transplant is worse than just being bald, believe me. My goal is to just try to look normal. So nothing would make me happier than hearing that all the Bosley clinics were using the latest methods and getting amazing results. Because Bosley is the biggest HT clinic in the world, so they are in the position to either help or harm a whole lot of guys, depending on how they conduct their business. I don't WANT any clinic to give people bad or not-so-great transplants, because I have one of those, and I know how bad it sucks to have to wake up every morning and see it in the bathroom mirror. All I am saying is that some of us hope that Bosley does do good work, does treat clients fairly etc. That was not always true in the past, though. I think you understand that. You said you thought the techs were wearing large eyeglasses. These sound like jewelers' loupes ("loops") which I believe have 3 to 6 times magnification. A lot of us here are fans of the doctors who use microscopes (20 times magnification) to dissect the grafts. The superior visualization can allegegly result in 20 to 30 percent increases in graft yield, in any given donor strip. In other words there is a chance that the clinics who don't use microscopes may be wasting precious donor hair. I know you said you aren't certain what the magnification was. Zeiss also makes head-mounted magnifying lenses that have ridiculous amounts of power (100 times magnification I believe) but I am certain that these are rarely used in the industry except by (maybe) the doctor. It is standard for everyone to use loops, and the clinics who use even the 20x microscopes are a minority. Bosley has been known to NOT use microscopes, at except one clinic (I think). One way for Bosley to make their clinics better would be to buy and train their people on the microscopes, but many clinics don't want to spend the money that would take. They would rather save money than save donor hair. This is something for you to look into (the importance of microscopes). There are some good articles and scientific papers about the importance of microscopes in graft dissection, why the all-FU transplant is considered state of the art, etc. Also, you say that whether you go back for additional sessions is entirely up to you. That is true, but it ignores one of the realities of hair transplants: that it is not good to walk around with a hair transplant that doesn't look finished. It can look not-so-hot, or even bizarre. So in that way, you are sort of "hooked". This is what Ken was referring to with the comments about "first starts". The first surgery is the hardest one to sell. After that, the patient will come back on his own. Not because "hair transplants are addictive" or anything like that, but because it can suck to have an unfinished transplant. So you can say that it's your choice whether you continue or not with more surgery, but my answer is that it's not entirely your choice, because many guys will get additional surgery out of necessity. That is not really a choice. I don't think that a clinic should tell anybody that 2000 grafts will be all they ever need. Patients should be made aware from the beginning that more surgery might be necessary. These clinics tend to try to sell people on the best-case scenario, rather than spell out all the possible complications. They could have told you you might possibly need double or triple that number of grafts, over the next few years. Depending on what happens witrh your remaining hair, it's certainly possible. Everybody is different and everyone has different hair characteristics and different expectations and different definition of what success looks like. Some guys have such good characteristics that they can go to a so-so surgeon, and come out looking good. Other guys have worse characteristics... they can go to a really good surgeon, and come out looking only so-so. There are a lot of variables at work. I tell guys not to settle for less when it comes to hair transplants, it is one of the first things people will notice about you. I personally don't think "pretty good" is good enough. Pretty good looks like a hair transplant, and I don;t think anyone wants to have a hair transplant "look". The measure of success in cosmetic surgery is that it doesn't draw any attention to itself ("undetectible") I personally think that only an excellent transplant can pass that simple test, and a pretty good transplant doesn't cut the mustard. That is my perspective. We all have different tastes though. Please, be sure to post some photos at regular intervals. Take some photos for your own records, including the post-op phase if possible. I really do hope your transplant turns out great.

In my opinion, the only sensible reason to use body hair is because you have completely depleted the donor supply on your head. Body hair shouldn't be the first choice. I think most people already realize that, but in case there is somebody who doesn't...

Look on Dr. Woods' website. www.thewoodstechnique.com It shows a guy with extensive body hair work, He is holding up a ruler to show that his chest hair has grown several inches longer after being transplanted to his head. Look under the section "chest hair to scalp". There is also a guy Timetested who has had a lot of body hair transplanted. Remember that this is a new technique, so don't expect to find tons of examples. It is only done on certain patients who have depleted their regular donor supply, and has not been around for a long time yet. It takes a year for a HT to mature. Every year, there should be more and more evidence to look at.