arfy

Dr. Woods has his detractors, mostly other doctors (who feel threatened by his method) and some patients are angry that he won't reveal his techiques to the general community, where they could become widespread. People will claim that Woods' method will "transect" a lot of follicles (damage them) but this has not been born out by the reports of patients, who seem generally thrilled with their results. These claims of transection have yet to be substantiated. Claims of excellent results are readily available. Also, every hair transplant doctor in the world requires their patients to sign a legal waiver, before the surgery, EXCEPT Dr. Woods. That should tell you something. Downsides... Woods method is time consuming. Each graft is removed individually, and with care (to NOT damage them), so sessions can sometimes last all day. Woods is also more expensive than the typical strip excision doctor. Unfortunately for many men, cost is a factor for them. Also, Sydney is quite a ways away. There is more information on Woods, including patient reports, and an "Ask The Expert" column, at www.hairlosshelp.com

Every patient has to find the balance between density (nearness of the grafts to each other), and the amount of area those grafts can cover. There is a limited amount of donor hair, so almost everyone will have to choose between the two. That's why many transplant patients wind up with very thin or bald crowns. There is not enough donor hair for density AND "full coverage". If you read the article "The Logic of Follicular Unit Transplantation" in the "Research Library" section of this website, it explains this concept in detail. It proves mathematically that Minigrafts can never provide "more density", only bigger gaps between the grafts you have. (They are not as efficient). Hair transplants do not result in big bushy hair like you had as a teen. A good one might look like you've been thinning and receding, but like you've managed to hang on to some of your original hair. It is not a "full head of hair". Also, comparing what your results might be, to other patients that you see, requires a little caution. They may have had more (or less) balding, or donor density, or more or less favorable factors in their corner than you do. A good doctor will be able to tell you exactly what to expect, in relation to those other patients. The "density issue" you are seeing is a limitation of ALL hair transplants, not just the Follicular Unit transplants. Go for the most natural looking grafts (FUs), because if your grafts don't look natural, it doesn't matter how much density you have!

You may want to look into Dr. Ray Woods in Sydney, Australia, if the removal of the donor strip is an issue with you. Dr. Woods has pioneered a unique method of removing single Follicular Unit grafts (the best kind of grafts BTW) from areas around the back and sides of your head. Only the graft is removed, with no excess tissue being taken. There is no donor strip removal, and his procedure is much less invasive than a strip excision surgery. Woods does small sessions (600 grafts or so per day) but can actually do several over the course of a few days. He recently did over 4000 grafts on a fellow, over the course of ten days. Even though that doesn't seem like a lot of grafts per session, Woods' method can actually be completed in a much shorter time than a traditional strip excision. A strip excision session can only be done once every ten months or so, because of the time required for healing, and to regain a normal laxity in the scalp. Keep in mind that each graft is removed and placed personally by Dr. Woods and Dr. Campbell, there are no technicians involved, only the two physicians. Also, many guys who get strip excisions get swelling in the forehead and around the eyes, several days after the surgery. Woods claims that is not as big of an issue with his technique, and that healing is faster with his method. Two factors seem to put some guys off of Woods: Cost and distance. However, if you are an airline pilot, plane fare will not be a factor, and price should not be either. If you do some internet research on Dr. Woods, I believe you will be suitably impressed. Many claim that he is the best in the world, and his method is certainly unique. Many patients are willing to pay a little more, in order to not have a linear donor scar. Although Woods' method has drawn criticism from other surgeons, (mainly because he has kept it a secret) patients of his report that they are very pleased. Spencer Kobren recently had a Woods patient on his radio show, and he commented that the fellow looked "amazing", with a frontal hairline as good as anything he had seen from Dr. Bernstein or Dr. Shapiro. That is high praise. Read this interview with Dr. Woods to find out more: http://www.hairlosshelp.com/html/survivordoctor.cfm [This message was edited by arfy on January 03, 2002 at 11:31 PM.]

http://www.hairlosshelp.com/html/rogainefoam.cfm [This message was edited by arfy on January 03, 2002 at 04:28 PM.]

If I were you, I would find out which doctors are "THE BEST" and travel to see them. If you were getting a heart transplant, you'd fly halfway across the globe to find the best doctor. Hair transplantation is as much a specialty, and although cost is a factor, it should not be one of the deciding factors in which doctor you choose. Also, I know flights to New York are especially cheap right now ($250 round-trip, or less) so I would consider Dr. Bernstein in New York as well. Don't base your decision on convenience or cost, or you increase the risk of being less-than-thrilled with your result. Don't gamble with your appearance, decide who is "#1" and give your business to them.

A good transplant will still look good twenty years from now. In other words, if a doctor gives you a hairline that looks right for a guy in his twenties, later when you are in your forties you will not look natural. And I doubt you will be happy with a forty-year-old's hairline right now, even though that is probably the right thing for a transplant surgeon to do. So you are in a difficult position. Before you decide that you want a hair transplant, learn everything you can about them. They have their limitations, and a younger guy might not be able to be satisfied with one, even a good one. There is a limited amount of donor hair, a hair transplant doesn't create any new hair, it just moves hair from the back and sides to the top. They can only acheive a limited amount of density, for example, plus as I said, the issue of the older guy's "receded" hairline usually being the correct one to transplant. How long have you been using Propecia and Minoxidil? Some guys take up to a year (sometimes even two years) to see results. Also, hang in there because new therapies are being developed all the time. For example there is Dutasteride coming in a few months, and there will be a new "foam" Minoxidil soon, which is supposed to be more effective due to better absorption. Because your hairloss is recent, the potential is there to see good results from drug therapy. Also, supposedly Lysine makes Propecia and Minoxidil more effective, so look into that. (and it is cheap). Good luck, and don't rush into anything. Also, there are a couple of guys your age who post in the "General" forum at www.hairlosshelp.com, you might want to check for posts from "Cowboy_Dallas" there. You might get some "moral support" for your predicament.

I doubt the Propecia is causing your problem, because it doesn't take 5 years for side effects to show up. You would have had problems years ago, if you were succeptible. Lysine supposedly can make Propecia and Minoxidil more effective. It has nothing to with side effects. Maybe you are thinking of arginine, which doesn't have anything to do with Propecia specifically, but supposedly can help some men achieve firmer erections. (I believe it can raise the level of nitric oxide in the bloodstream.) I'm not convinced your letter is legitimate. For someone who's been using Propecia for "5 years" as you claim, you don't know much about it.

I don't think there is such a thing as a completely undetectable hair transplant. The closest you will get is from an "all-FU graft" procedure, but there are still little tell-tale signs. You can only imitate nature, not duplicate it. Also, you don't get nearly enough hair from a hair transplant to wear a "flat top", etc. There's not even enough donor hair to do your whole head, if you will ever be completely bald (which is probable if you need a hair transplant in the first place.) Guys who are considering a hair transplant REALLY need to understand this. You just don't have enough donor hair to cover a completely bald head. That's why most ethical transplant docs will not use up a lot of grafts in a patient's crown. The grafts are needed more in the frontal hairline, and behind that area. "Framing the face" is considered the main objective. Hair transplants create an "illusion" that you still have "some hair". The reason you wouldn't wear your hair standing straight up is because you will get better coverage of your baldness by wearing wearing it "down". It's like a combover, except the hair is spread out over most of your head, not just on the side. Don't expect "rock star hair" or even "cool" hair from a hair transplant. The best you can hope for is something natural looking, that makes it look like you've halted your hairloss, and still managed to hang on to a little of it.

I'm glad you're happy, but I bet you could be even happier. The all-FU transplant looks the most natural. No matter how many grafts you get, or how much "surrounding hair" falls out, the grafted hair will always look completely natural. (In the right hands, of course.) Minigrafts will not look natural in the rain, in the wind, etc. They need surrounding hair (or FU grafts) to help conceal them. What is the point of using grafts that need to be concealed? These grafts are supposed to conceal your thinning hair, and yet they also need to be concealed. It doesn't make any sense. I'm glad you're happy with your transplant so far. But I bet you would be even happier with an all FU procedure. The difference between your mixed-graft transplant and an all-FU transplant can be subtle, but it is the difference between a good looking transplant and a great looking one. I think everyone should go for the best possible result, since you will have to live with it for the rest of your life. Don't settle for anything less than "amazing". Since there are no guarantees given with hair transplants, there is a risk. More guys will be "more happy, more often" with an all-FU transplant. If you are satisfied, I congratulate you. But I wouldn't recommend other people get a "mixed graft" transplant like you did. Read the article here called "The Best Procedure" which describes the state-of-the-art transplant.

No I am not a doctor. If I was a doctor I wouldn't be posting under a nickname. What "medical advice" am i dispensing? This is all common sense stuff anyone can pick up, from reading the comments and scientific papers from the doctors themselves. "Watch out for shock fallout." Most doctors don't mention it unless you bring it up first. Even then, many doctors and their salesmen (I meant "consultants") dismiss the whole thing as a "non-issue". Including Matt, Dr. Shapiro's consultant, who tells patients it is nothing to be concerned about. I also tell guys to try to keep as much of their natural hair as possible. Since this should be a "no-brainer", I'm assuming that you probably object to this cutting into your bottom line. Since you are a technician, maybe you can post the available data on the occurence of shock fallout, for all of us to read. I'd be curious to see it. Thank you in advance. And I promise not to lump in all the bad transplant doctors with the good ones. I agree that the dozen or so "good" ones deserve to be in a special group, kept apart from the 3,000 crappy ones. And by the way, what do you think the purpose of this forum is? This is a place where PATIENTS can share information. If you pay attention, you will see I have almost never posted anything in the forum where questions are directed to doctors. (Two posts, one was to a "Question for Doctors and Patients". The only people who have a problem with patients sharing information and learning from each other are the sleazy doctors. The good ones welcome the idea of an "informed patient". Only a shady doctor would have any reason to resist the idea of an educated public. Even though I am happy to stay out of the doctors' forums, they still feel free to post in the patient's forums whenever they please. Why don't you tell us who signs your paycheck? I'm sure he's a real winner. Maybe he can help you find that shock fallout data. [This message was edited by arfy on December 12, 2001 at 08:03 PM.]

Definitely avoid Dr. Carlos Puig in Houston, Texas. He works for MHR (Medical Hair Restoration) and you should avoid them in general as well. He gave me an unbelievably crappy hair transplant, in fact this hack has practically ruined my life. He's a disgrace to the field of medicine. Try clicking on the map at the top of the page to see who Pat recommends. If none of the nearby doctors sounds appealing, find the very best doctor you can, and get on a plane and see him. If you were going to get a HEART transplant, you would fly across the globe to see the best doctor you could find. A HAIR transplant shouldn't be any different. The majority of doctors are doing mediocre-looking work at best, and many are doing really lousy work as well. An "okay" looking transplant isn't worth paying a penny for, since it will be one of the first things people will notice about you. You won't necessarily spend any more on an amazing looking one than you would on an awful one, so don't settle for anything less than the best, since you will have to live with it for the rest of your life How old are you? Where are you on the Norwood scale? Are you using Propecia or Minoxidil? Are you at risk for shock fallout?

There was a study done on Lysine, you can read it at www.TheBaldTruth.com Nizoral shampoo will help with itching, flaking and side effects of Minoxidil. Supposedly it can also increase hair shaft diameter. It is not going to be the center of your program, but it is a little extra something, especially if Minoxidil causes problems for you. As far as expensive shampoos like Dr. Procter's, I hear they make your hair feel nice but won't do much of anything else.

There is a lot of interest in this area, since it will solve the biggest problem with transplants, the limited amount of donor hair. Nobody has a definite answer to your question of "how long". Some people say it will be available in 10 years. Others have said they think it will be 5 years. There are some people who think it will be even less than this, and apparantly a few people who have warned there is a possibilty it could take much longer than 10 years. I would say start keeping an eye out. Even though the articles at www.clonemyhair.com are too technical for me to understand, I still check there from time to time. It looks like progress is slowly being made, because there are always new papers listed in the news there. Hopefully at some point all the pieces of the puzzle will be there... A company who has been working on it, who has said that in two years they should be able to conduct tests, and they expect to make it available in 10 years is www.intercytex.com. Of course, who knows what could happen in the meantime.

My first questions is "who is your doctor?" Does he use follicular units? This is a crucial question you should be asking before any surgery. There is the possibility of shock fallout of your natural hair. Hopefully, if your hair loss has been halted, the drug therapy will prevent this from happening. Stay on top of this treatment, because it is crucial to keep as much natural hair as possible. In fact, you shouldn't assume that you will become completely bald. That may not have to happen. And a hair transplant on a completely balding head will not look nearly as good as one where you still maintain some hair. Where are you on the Norwood scale? Getting a hair transplant to "stay ahead of your baldness" is a big mistake, in my opinion. Also, most ethical doctors will not transplant into the crown. There is a limited amount of donor hair, and it needs to be reserved for the front hairline and behind that. If you transplant into the crown, you may not have enough hair to do the hairline as well as you need to.

I came across this: http://www.hairlosshelp.com/forums/messageview.cfm?catid=5&threadid=847&highlight_key=y&keyword1=sword

I answered this in your other post, so look there. But I have heard he is NOT good...

I don't have any first-hand experience with him. But I have read some pretty disturbing comments about him from Dr. Sword's former patients, at www.TheBaldTruth.com. Look in the forums there (Do a search on "sword"). If I were you, I'd use Pat's list to find a doctor who does an "all-Follicular Unit" transplant. Read the article here called The Best Procedure (on the left) to learn why the "all-FU" transplant is the most natural looking. The all-FU transplant is the ONLY way to go!

You should consider using Propecia and Minoxidl together. By combining their use, you should be able to get better results than if you used them alone. Also, consider adding Lysine to your routine, which may make those drugs more effective. As far as doing research, I think you can do a lot of legwork on the internet. This site has lots of good info. Read "The Best Procedure" and consider reading the articles in the Research Library. They are a little technical but very good. Other sites with good articles and forums are www.TheBaldTruth.com and www.HairlossHelp.com. These sites cover drug therapy (like Propecia) a little more thoroughly than this site, and you may find them useful. If you want to research different doctors, try looking at Pat's list of recommended doctors, and the recommended list at The Bald Truth. Then find these doctors' websites, and read up on them. Also, do searches on the docs you are interested in, in the forums of the websites I mentioned, to get comments and feedback from real patients who have had experience. There is a lot of reading, but this is the way to go. Right now, I would not suggest visiting any clinics. For one thing, most doctors don't have time to explain everything you need to know, in order to make an "informed decision". Since you are more interested in learning about the field for possible future procedures, it is premature to start meeting doctors. Learn about the field, and find out which doctors seem like the best choices. If you are still interested in pursuing a hair transplant in the future, then you can start trying to interview prospective surgeons. First though, learn as much as you can by using the internet. And by the way, 2 or 3 months is not enough time to decide if a drug therapy is working for your hair. Most people say to give Propecia a year of consistent use, to decide if you want to continue. If you are able to halt your hairloss, it is worth staying on it, and this seems like a reasonable goal.

Dr. Limmer said Woods' technique is "basically the punch hair transplant technique first introduced by Okuda in the late 1930's and resurrected by Norman Orentreich in 1958. The difference in Woods technique is that it utilizes a very small punch." From what I understand, this is not true, Woods does not use a punch. Why do these critics say there are too many "unknowns" about Woods' technique, then turn around and try to explain it to us? I agree with Dr. Limmer when he says "My only recommendation would be to do your homework well and to speak with multiple patients who have previously utilized the physician you wish to consider." Well, that wouldn't be my ONLY recommendation, but it's a start...

Gary A donor scar could stretch "while" it is healing. Tension on the sutures causes it to happen. If you had a big session (lots of donor scalp removed) or if this is a 2nd, 3rd, 4th procedure etc, it adds to the tightness of the scalp, raising your risk. Obviously a bad donor scar is not the result for every patient, but there is a risk involved.

You should be on Propecia and probably Rogaine, first and foremost. Lysine can make these treatments more effective. Because you need to try and retain as much of your natural hair as possible, even if you decide to get a hair transplant. The more natural hair you've got, the better. Even if you don't reverse your hair loss, you should definitely make an attempt to halt it from progressing. If you get a transplant, it is important to have stableized your hairloss first. It may help against "shock fallout". And getting a transplant to "stay ahead of your hair loss" is a mistake. A transplant can make your situation worse, if you do suffer from a lot of shock fallout. And since there is not enough donor hair to cover a completely bald head, you need all the natural hair you still have. There are no guarantees that you will like your results when you are done. In fact, doctors will require you to sign a legal waiver before the surgery, which helps them avoid lawsuits from unhappy customers. Price is usually based per graft, which can range from 4 to 10 bucks per graft. This is a ballpark range, some doctors chrge more and some charge less. Some of the best doctors only charge 5 or 6 bucks per graft. If you need 2000 grafts, you will spend twelve grand. And you should assume that you will need to get more work in the future, if you keep losing hair over time. A crappy transplant will cost as much as a good one. Don't go to a transplant doctor because they are convenient or cheap, find the best doctor and be willing to travel. Look at as the same type of sub-specialty as getting a heart transplant. You would want to find a top doctor for that, and you'd fly around the world if necessary. It sounds like you are just learning about transplants. Be careful and educate yourself fully before you get any surgery. There is a risk involved, and thousands of uninformed guys have had their lives ruined by a bad transplant. There is no one to protect you, not the AMA, not anyone. Protect yourself by learning as much as possible before you decide that is what you want.

It says it can be removed with "no lasting scars". I didn't know there was such a thing as a temporary scar. Every surgical procedure results in some type of scar. It appears that they are surgically "anchoring" the filaments. How can that NOT create a scar?

I know of one patient who "attempted suicide" because he was unhappy with his transplant from Dr. Brandy. There was a newspaper story about it. I will try to track it down. The guy was suing Brandy, saying his transplant was the reason he was driven to attempt suicide. I don't know how much the donor scar was a factor in that. I'll try to locate that on the web. I also look at the hairlosshelp web site, and there are indeed complaints about donor scars in their forums. I've also read posts about donor scar problems at thebaldtruth.com. It does happen, maybe not to every patient, but it is a problem. Proof of that is at the recent ISHRS conference. There was a seminar about revising unacceptable donor scars. If they have to do a seminar about it, it is certainly an issue. I'm sure this is NOT the first year they have had to cover this subject! Also, Gary asked if Woods method is valid, why is it not "catching on" with other doctors? Actually, I think it is. NHI is trying to develop their own version of it. And even the doctors who slam it (Knudsen etc) say they would love to know how it works. So the interest is definitely there. Whether they can catch up with Woods' 12 years of experience in developing his technique remains to be seen. [This message was edited by arfy on November 20, 2001 at 02:02 PM.]

If I were you I'd be trying to hang on to all of my natural hair, by using Finasteride, Minoxidil, Lysine, and Nizoral shampoo. Even if you go the surgical route, you need to maintain as much of your natural hair as possible. There is not enough donor hair for most guys to get a great result if they are completely bald (you'd probably have to settle for a bald crown). Even if you had the donor hair, it would cost a fortune to transplant that many grafts, so save all of your hair, first and foremost. Also, in my opinion you should halt the progression of your hairloss before going the surgical route. Hair transplant as an insurance against "future baldness" is a bad idea, because of shock fallout and other reasons. Because you're relatively young, you should be able to halt (or even reverse) your thinning. In a few months Dutasteride should be available, if Finasteride hasn't been working for you. That might do the trick for you. By the time you're 30, there may be a whole bunch of new drugs and technologies available. If I were you, I'd try to work with what you've got, and hold off for a while. Just my 3 cents...

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