arfy

Well, first I should say that Dr. Shapiro seems like a fantastic HT doctor. I don't recall ever hearing anyone say he did a bad job on them, in the 2 or 3 years I have been looking at these online forums. That's pretty impressive.

 

However, you are asking for "negatives".

 

I really wish that Dr. Shapiro did his own consultations. Instead, he has a "consultant" (a non-physician) meet with potential patients. Many doctors do prefer to meet with patients themselves, and I personally prefer doctors who work this way. The consultant is not going to be there in the operating room, explaining everything you discussed with him, to the doctor. In other words, that was a missed opportunity for you to get some feedback from the guy who actually does the work... instead you've been talking to a salesman, essentially.

 

Now I expect that this will raise some hackles here, but this is not just my opinion, a lot of the top doctors feel the same way. Some say that the doctor is "just too busy" to meet with potential patients. The fact is that ALL doctors are busy. This is the only field of medicine that employs front-office salesmen, as a way to secure customers. Half the battle with a hair transplant is getting a good solid connection between the patient and the doctor, so that both sides are "on the same page". A consultant is an obstacle in that process, in my opinion.

 

Also, many clinics abuse the use of consultants, so when "good" clinics choose to use them, I find it disturbing. For example, it is illegal for the consultant to make any surgical recommendations. It is also illegal for the consultant to schedule surgery BEFORE you have actually met the doctor. However, these kinds of violations happen all the time. (The laws may vary from state to state on these issues).

 

Consultants are the product of the "hair mill" system, where the point is to churn out as many generic transplants as possible, in order to make as much money as possible. "Hair mills" are responsible for damaging literally millions of guys, over the last 30 years. So when I hear that certain "excellent" doctors choose to use a consultant, rather than meet with the patients right from the beginning, it bothers me.

 

Personally, I wish that Dr. Shapiro didn't choose to use a consultant. This doesn't mean that Dr. Shapiro necessarily uses his consultants "innappropriately", but my opinion is that in general, consultants should be avoided. Spend your time speaking directly to the person who will operate on you.

 

Sorry if this offends anyone, but that's how I feel.

 

(By the way, I think Dr. Shapiro does excellent-looking hairlines.)

First of all, I hope you are using Propecia in order to prevent further hair loss. Hair transplants do not prevent baldness, you need to put the brakes on further recession ASAP. Yes, start using Propecia before, during and after a HT. If guys would use it from the early signsof hair loss, they might be able to avoid ever needing a HT in the first place.

 

Maybe you already know that, if so, I apologize for being redundant.

 

Also, if you only think you need a thousand grafts, I think you should really be sure that you actually need a surgery. I see lots of guys asking about transplants, who just want to touch up their hairlines, or fill in their temples a little. Getting a surgery to accomplish this goal is an extreme reaction to that degree of hairloss, and a mistake, in my opinion. Don't even begin to think about HT until AT LEAST Norwood 3 and up. This issue has been discussed many times here in the forum, so you may want to spend some time going through older posts, and reading your way backwards (or forwards...)

 

Picking a world-class doctor is crucial, but it is equally important to be a "good candidate" for the surgery in the first place. There are too many clinics out there, who tell every single guy who comes in with a little thinning or recession, that "of COURSE you are a great candidate for a transplant!" (as long as you have the money). There are even some "good" clinics who seem to be guilty of this, so be careful. Just because a doctor is willing to do a HT on you, doesn't mean it is a good decision for you.

 

Okay, you've been using Propecia and halted your hair loss, and you are beyond Norwood 3, and the Propecia didn't regrow anything for you. You are certain you are a good candidate, you've researched and read up, and informed yourself. You are asking "who is recommended, Joe Greco or Dr. Shapiro?"

 

Well for one thing, Dr. Shapiro has the reputation of being one of the very top HT physicians in the world. Certainly "top ten". Joe Greco has his share of fans here, but I have never heard anyone claim that he is #1, the way many people do about Dr. Shapiro.

 

For another thing, Joe Greco is not a medical doctor, he's a "PA" (physician's assistant). He has a phD in something or other, but nobody ever says what he got his phD for. But he certainly should not refer to himself as "Dr. Greco" unless he's trying to pull a fast one on you. Now I'm sure Joe Greco's fans will cry "foul" here, but these are the facts. He's not a doctor, and some people think that is important.

 

I believe Joe Greco was once Dr. Shapiro's assistant. I may be wrong about that.

 

Bottom line? Hands down, I would pick Dr. Shapiro over Joe Greco. No contest.

I hear that pressure has caused the FTC to require Avacor to change their advertising. Because right now, they don't even mention Minoxidil, and they also claim it is "all-natural" which Minoxidil is not. They make all kinds of false claims.

 

It's a scam product, and I am sorry guys are wasting their money on it. It just encourages other companies to try to rip us off, too.

 

Did you know that doctor in the Avacor commercials spent a couple years in a federal prison, for ripping off Medicare or Medicaid? He's a convicted felon. He ripped off the federal government, how worried do you think he is about fleecing "the average guy"?

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>what if there would be no significant hairloss in the subject later on - would filling in recessions on the sides still be not a good idea

Lord Rahl, you said you have diffuse thinning on top of your head, and you are just starting Propecia. So I wonder how you can feel confident that there will be no further hairloss for you? The problem is that you can't. Countless younger guys have gotten touch-up work for their hairline, and have regretted it. For one thing, the surgery can cause "shock fallout" where your hairloss is accelerated after the surgery. There are some people who have ended up with LESS hair after a hair transplant. That's why many docs do not do small touch-up sessions, the risk of "net loss" is not worth the "net gain". The best candidates are guys with a well-defined pattern of hair loss, who have already stopped losing hair with propecia, who don't have unrealistic expectations about what a HT can do for them. None of these things sound like you, to be honest...!

 

Another thing to consider. Your HT hairline will never change...EVER. If a surgeon gives you a straight teenage hairline, or one that looks especially young, it will look bizarre as you get older. Very few men have a "Ronald Reagan" hairline as they become older, and it will not be natural looking. And if you DO continue to lose hair, things will be even worse, because you will have a hairline that "draws a line in the sand" that is too large to fill with in with grafts. You'd have a teenage hairline, and hardly any hair behind it. It will NOT look good!

 

Why does it seem like some younger guys are so upset about losing their hair, that they can't accept the concept of recessed temples? And by the way, another thing you need to understand about a HT... you will most likely have to be satisfied with a bald or very thin crown, eventually. A hair transplant does not leave you with "Elvis" hair, there is not enough donor area. Older guys are better candidates because they are happy just to have a little coverage, evn though it is thin. Younger guys are usually not good candidates because they are trying to "look the way they used to" which is basically impossible for the vast majority of guys, and a big mistake.

 

I hope you will slow down and listen and think, and that you don't actually need to learn these things the hard way. Not only are people on the forum saying this, but now you have doctors telling you too. Although I'm sure that you will be able to find some clinic who is willing to take your money, and give you any hairline you want...

Hi RBM02

If I were you, I'd get a prescription for Propecia from your doctor or a dermatologist. Propecia is reported to halt further hairloss in something like 80 percent of all users. If you can nip this in the bud, you will be ahead of the game. It's easier to maintain your existing hair, than it is to regrow hair. A smaller percentage of guys can reverse their hair loss, but that's not as common as stopping it, or slowing it way, way down.

 

Both those products can be very effective all over your head. They were only studied in the crown area, during the FDA tests, so they are restricted from making claims about the hairline. But that doesn't mean they won't work there.

 

If I were you, I'd get started on Propecia immediately, and think of it as a long-term treatment. Give it a year or so, to judge your results.

 

Minoxidil can help, but in your case, you might want to start with the simplest approach first, and only add to your routine if it is really necessary. Minoxidil is not as convenient or as effective, so if Propecia works for you by itself, that is worth knowing. Otherwise, if you do decide to add Minoxidil later on, those two things work great in tandem.

 

Shaving your head will not slow your hair loss down, or speed it up either. If "no guard" on the razor means you are nicking yourself, that's not good in general. I hear the Mach 3 disposable razors are a little more expensive, but great for shaving your head.

 

Good luck.

I think the general consensus is to give it a year. I've heard of guys taking even longer than that, though.

 

As long as Propecia can slow down your hair loss (if not actually stop it) it's a small victory, in my opinion. If you actually stop losing hair, even better. Because it's important to try not to lose any more ground.

If you have some "original hair" left, from using Propecia etc, it will help make your HT look better. If all you have are grafts to provide coverage, a HT doesn't result in a glorious mane of dense hair. A good one looks natural, and it looks like maybe you have lost some hair, but have managed to hang on to a decent amount. In other words, a guy who is totally bald who gets a HT, will probably not look any better than where you're at right now. HTs don't give you "rock star hair" unfortunately. There's not enough donor hair for that.

 

Since you have some hair, that's good, it helps with your end-result. But you can't presume that hair will never be lost down the road, especially if you actually need a HT in the first place. I wouldn't bet on it... Also, there is the chance of "shock fallout" where the surgery can sometimes cause your hair loss to accelerate. Sometimes that hair will grow back in time, and sometimes it is gone for good. It may or may not even occur in your case. But it is something to factor into your decision. That's one reason you should be using Propecia, it might help prevent shock fallout.

 

If your doctor claims shock fallout won't be an issue for you, ask for that in writing.

 

If i were you, I would see Dr. Bernstein in NYC, he doesn't pressure guys into getting surgery. He may tell you not to get a HT for now, and if he does, BELIEVE HIM...! Or he may say thumbs up, or that it's your decision on what to do. But I would trust his opinion, and if you are serious about considering HT, you should see more than one doctor anyway. (I remember you asking about doctors in the New England area).

 

Good luck.

With your level of hair loss, I think you'd be nuts to get a HT without giving Propecia or Proscar a solid chance (a year of steady use).

 

Even if you get a HT, you need to use Propecia (Finasteride) to maintain your remaining hair. You don't just let it all fall out, and think that you can replace it all with a HT (you can't). That doesn't make any sense. For one thing, you have a limited amount of hair in the donor hair "bank", not nearly enough to cover your whole head with any significant amount of density. The demand is greater than the supply.

 

In fact, you really should have gotten on Finasteride years ago, but I guess that is water under the bridge...

 

If money is not an issue for you, I would use Propecia, it's just a little easier. If you have a wife or kids around, you might not want to cut the Proscar tablets (which do have tiny amount of residue...powdered tablet...after you cut them.) Finasteride should be kept away from women and children...

 

If money is an issue, it is cheaper to use Proscar. Proscar is a 5 mg. dose of Finasteride, where Propecia is a 1mg dose. Since you are in your 30's, it's possible your doctor will be sympathetic if you explain your financial hardship, and prescribe Proscar (which is really for Benign Prostatic Hypertrophy... I think I said that right) in other words an enlarged prostate gland. Since it is unlikely a guy in his 20s would have that condition, your age might allow your doc to cut you some slack, and prescribe the less-expensive version.

 

Then pick up a tablet splitter at your pharmacy (ask your pharmacist) they are about 3 or 4 bucks. Use it to split your Proscar into quarters, which is technically impossible since a tablet of Proscar is 5-sided. Just do the best you can, figuring that the main thing is a "total weekly dose". So you'll actually be getting a 1.25 mg dose, on average.

 

If I were you, I'd get a prescription for Propecia like, tomorrow. ASAP certainly.

 

Hopefully you will halt your hair loss (according to Merck 83% of guys will halt or dramatically slow hair loss down) or even regrow some hair (possible but less likely... worth a try). If you try to treat your hair loss in a preventative way (maybe Minoxidil too, if you are inclined) hopefully you will never get to the point that you really need a HT. Let's hope so!

 

As I said, even if you do get a HT at some point, you should still use Finasteride, because HT do not prevent further hair loss. You need to retain as much "original hair" as possible.

 

Good luck.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR> "It may be a long trip but its my head and you can only start doing this type of thing once and its best to get it right at the start!!"

EXACTLY RIGHT.

 

Either get a world-class doctor to do it, or don't get it done in the first place.

 

Because you only have one chance to get it right.

 

I am in the process of getting a crappy HT "fixed" and it is time-consuming, expensive, and will never look as good as it would have, if I would have gotten good work.

 

Do it right, or don't do it at all.

Dutasteride is not available here, yet.

 

I wish I had some good advice regarding your shedding. I've seen other people suggest "just ride it out", or in other cases consider increasing your dosage. Another option would be to consider adding to your regimen, although I'm not sure what to suggest. Propecia is currently the best treatment available.

 

Hopefully this shedding phase will subside, I believe they are typically temporary.

 

Hang in there...

Dr. Cohen is on the "recommended list" at this website. Apparently Dr. Cohen is using the latest techniques. I don't have any personal experience with him, so I can't give you any feedback.

 

Regarding Bosley, I think you made a good decision, but not just because of their sales tactics. Look at this page that describes the "ultimate grafting technique" (which is not what Bosley uses): "Best Hair Transplant" You need to find a surgeon who specializes in this approach (microscopic dissection, and exclusively using "FU grafts", or at least used as the vast majority of grafts). This should be the basic criteria when looking for a surgeon.

 

If you are looking in New York City, I would suggest Dr. Bernstein.

 

You can see all the "recommended" doctors and get more specific information about them if you look at the "Find a Great Surgeon" page.

 

If I were you, I would try to consult with several of these doctors, and weigh your options carefully.

Hi Monty

The terminology has never been firmly established, and I think it can get a little confusing. Some clinics even try to take advantage of patients' confusion, by using the terms to suit their purposes.

 

But in this case, this fellow "Math" is not necessarily describing the "gold standard" grafts incorrectly...

 

"micro follicular unit transplant"

 

"Micro" in this case will hopefully describe microscopic dissection.

 

Also, theoretically a FU graft is a sub-category of Micrograft. A FU graft is a micrograft trimmed under a microscope.

 

I know this is splitting hairs, and getting a little anal-retentive on my part...sorry.

 

Look at how Pat describes FUs on the following page. As long as patients follow these guidelines, they will be getting a modern procedure: http://www.hairtransplantnetwork.com/Best_hair_transplant_procedure/index.asp

 

I for one, would like to see doctors come up with a more recognizable way to describe this approach, that would be confusion-free.

Read the "Best Procedure" part of this website: http://www.hairtransplantnetwork.com/Best_hair_transplant_procedure/index.asp

 

Ask if they use only Follicular Unit grafts, that are dissected under a microscope.

 

Ask if you can see a procedure being performed (if you are interested).

 

Ask if you should use medication like Propecia, either with or instead of surgery.

 

Ask if you might lose hair from shock fallout, after the surgery. If they say it definitely won't happen, can they guarantee that in writing?

 

Ask if they can give you a hairline that will still look natural in 30 years.

 

Ask if you can see patients of theirs, in person. Not just a guy who happens to work there.

The "numbing" does hurt, in my opinion.

 

I'm a repair patient, and I no longer have full sensation in my scalp, and it still hurts to get numbed.

 

Unbearable pain? No.

 

White knuckles? Sometimes.

 

This part of the process only lasts about 15 minutes, and is considered tolerable... unpleasant yes but necessary.

 

So it isn't really accurate to call a hair transplant "pain free". The surgery itself is painless, but the anaesthesia is not.

JonathonNY

I am not crystal-clear on the history, but an approximate history would be that Dr. Limmer in Texas started using microscopic dissection and close-trimming of grafts around 1988.

 

Dr. Rassman and Dr. Bernstein picked up the ball and ran with it, starting around 1994.

 

Unfortunately, most doctors are still using the old Minigraft technique, although things seem to be changing.

 

I don't know anything about Dr. Law, but only a few doctors in the world have as much experience with FUs as Dr. Bernstein. He is also rated high for repair work.

 

It wouldn't hurt to meet with both doctors, and see what they recommend.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>Sound like mystical voodoo science to me.

I agree except for the "science" part.

 

Would you use "positive thinking" to prevent tooth decay?

 

Spend your time and money on treatments that work, like Propecia...

Steroids will not interfere with a transplant. However, transplants do not create any new hair, they just move a little from the back to the front. It's just not nearly as good as having a decent head of your own natural hair. Guys like you (with a good amount of hair left) should consider transplants as a last resort, and do whatever you can to halt your hair loss with Propecia and Minoxidil.

 

The bottom line is that it is far better to not lose hair in the first place. Hair transplants are an imperfect solution. If you do decide to get a hair transplant, be careful. Only a few doctors are doing excellent work, with the vast majority of HT being mediocre to poor. Hence the need for websites like this one.

 

I don't know what forums you read, but you might want to address hairloss questions to the steroid forum at www.testosterone.net I believe there may be some interactivity issues with Propecia and certain steroids. I would trust opinions on that site, regarding steroid issues.

 

For guys not into steroids but into weight training, it's a good website for training and nutrition information, including drug-free issues and concerns.

Hi Mike

With shock loss a big factor is "how strong" is the existing hair on your head? Follicles considered "at risk" for fallout anyway, may be lost earlier than expected.

 

In other words, there are a couple possibilities:

 

-Shockloss won't occur

 

-Shockloss will occur to some degree, but those hairs will return.

 

-Shockloss will occur and some hair will be lost for good.

 

This third example is why some docs recommend not doing little sessions, and prefer to do fairly big sessions. Because there could be some shock loss, leaving the patient with a "net loss" instead of a "net gain".

 

Also, shock loss can happen anywhere in the balding zone, it is not limited to the immediate area where the doctor placed the grafts. Think of shock loss as your hair reacting to a "general trauma".

 

Even though shockloss is an issue for you, it may not be the only issue. Guys who just want to touch up their hairline might not always be the best candidates for surgery. I don't know how much hair loss you have, but you should keep investigating before you decide to go forward with surgery. Many people say that HT is out of the question for anybody below Norwood 3. Look at Pat (website owner's) story, he was a good candidate. Guys who just want to fill in the temples a little, can be setting themselves up for problems down the road, because they are establishing a hairline that is too low. Keep in mind there is a limited amount of donor hair, not enough to cover a completely bald head. Filling in the temples can be "drawing a line in the sand" too low on your forhead, that you will not have enough donor hair to follow through on. The correct hairline in a hair transplant is considered "mature and recessed". Again, look at Pat's hairline. If you already have a similar or better hairline than in Pat's "after" picture, forget about HT for now. Because you would be gaining nothing, but at the same time committing yourself to a whole series of future surgical procedures.

 

Again, I don't know where you are on the Norwood scale. But guys who just need some work in the temples are often better off not getting a hair transplant. Even though it can look good at first, it can create a whole lot of big problems if and when you continue to lose hair. And you can't assume you won't continue to lose hair, if you need a HT in the first place.

 

By the way, the advice to get on Propecia is right-on. You should be using it whether you get a hair transplant or not.

Igor

Most patients will require multiple sessions.

 

I've never heard of a patient who didn't want more density or more coverage, even after multiple sessions. Anybody who only had one session, and never had any more, probably didn't really need one in the first place (or changed their mind about the wisdom of getting a hair transplant).

 

You will probably want as many sessions as you can afford, or until you run out of donor hair for. Hair transplants are not a "one-shot deal".

Gary

I think the 'archives" part of the show is out of commission. You could always try calling during the show, and asking directly...

 

I'd be curious to hear what you learn, once all the reports are in. Also, it would be great if you would keep us informed if you do decide to "get surgical" on these old scars...

 

Thanks!

Hi Luis

i have no experience with any of the clinics you mention. However I did see that at least one of them is using stereo-binocular microscopes to dissect their grafts. That's a good sign.

 

Don't go to a clinic that doesn't use microscopes. Clinics that dissect grafts using "Loops" (magnification worn as head gear) should be avoided.

 

I hope that helps...

I looked at their website, and it looks like they are not doing top-notch work. The best doctors are using microscopes to dissect "FU" grafts. However, their website may simply be out of date. http://www.chtg.com/

 

Ask them if they use microscopes to dissect their grafts. Microscopes can increase graft yield, reportedly by someing like 20 to 25 percent. Don't even think of going to a clinic that doesn't dissect all of their grafts with microscopes!

 

Read this: The Best Procedure which will explain what techniques are being used by the better doctors. If Dr. Goldstein does not use these methods EXCLUSIVELY (not just "once in a while") avoid him, and anyone else who doesn't use these methods.

 

Dr. Goldstein's website says he uses Minigraft and Micrograft techniques, which are old and outdated methods from the mid-80s. Clinics that use these methods are not doing the "best" work and will give you a generic (and probably pluggy) looking transplant. You can do MUCH better than Minigrafts and Micrografts!

 

However, to be fair, his website might just need updating. Ask him if he uses microscopes to dissect his grafts, and ask him if he exclusively uses Follicular Unit grafts. If he uses Minigrafts and Micrografts, you can do MUCH MUCH better than Dr. Goldstein.

 

Also, if I were you, I would do a lot of research on this website and on the internet before I sit down in somebody's operating room for a hair transplant. Read this website from top to bottom! Look at the "Find a Great Surgeon" section and read each doctors' website from top to bottom. This is called "doing your homework".

 

If you don't do your homework, you could get totally screwed.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR> dhi

 

their techniques and staff get better and better every day

This reply suggests there is still some room left for improvement.

 

Please don't settle for "pretty good" or "okay" or "they're getting better all the time" unless you want to risk that you might regret your hair transplant for the rest of your life.

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>would it be a wise course of action for me to receive 1,250-1,750 grafts to restore my frontal hairline and then take Propecia to prevent any further loss?

If I were you, I would get on Propecia right away, whether you get a hair transplant or not.

 

Personally, I think you are too young for a transplant. I know there are many doctors who dislike transplanting guys in their early 20s.

 

The correct hairline from a hair transplant will be recessed and mature looking, something that looks more age-appropriate for a guy in his 30s or 40s. Would you be satisfied with that?

 

If you try to return to your teenage hairline, if and when you continue to lose hair (very likely, almost certain, since you are losing hair so young), a low transplanted hairline will look great at first, and become a nightmare later.

 

(My apologies for posting in the "Ask A Surgeon" forum)

Hi Gary

I heard Spencer mention this (punching out circular open-donor scars) on his show last week. He didn't say which doctors used that method, but he was speaking with a fellow on the phone with open donor scars.

 

One issue about punching them out and suturing, that you will need to ask about... If the scar is too big, you will possibly "pucker" the suture if you just punch the whole thing out at once. The gap may be too big to close perfectly smoothly. I think that when it comes to big plugs (5mm) in the recipient area, many repair doctors only take out a section, and leave an outer "crescent" shape, due to the size/pucker problem. So I don't know if it is practical to try to remove each scar fully, all at once. The doctor may not be able to take the entire scar.

 

Keep in mind I am basing this reply on what happens in the repair of recipient areas (hairline etc) so maybe puckering is not considered a real problem in the donor area, where slight imperfections are concealed a little easier. You will need to look into this...

 

Also, if there are several scars in a small area, it may create too much tension to do more than a couple at a time. It might take a few "mini-sessions" to accomplish your goals...

 

If I were you, I would run this by your regular surgeon first, if I am not mistaken you did find someone who you like. Start there, keeping in mind that repair is a subspecialty and not all the "good" docs are best-suited for it.

 

If that isn't solving your dilemma, try contacting Dr. McLellan or Dr. Bernstein at NHI, or Dr. McAndrews (LosAngeles). Pat also recommended Dr. Vogel to me for repairs once, for another option.

 

You could certainly do "all of the above"... bring it up with your doctor (local to you, I believe) as well as a few other email-consultations, then weigh your options. Pick the doctor who seems to have the best approach for you, or seems like the best I suppose.

 

if everyone has the same approach, you could possibly stick with your regular doctor, because these repair operations seem to be less intensive (in every sense) than a grafting session, and it may not require travelling, from a practical standpoint.

 

I hope that helps...

 

[This message was edited by arfy on September 10, 2002 at 09:18 PM.]