Dr. Joseph Williams

54 year old female one year post-op having received a total of 2006 grafts utilizing custom cut blades:

250 single hair grafts into 0.8mm incisions in the hair line, 500 grafts into 1.1mm incisions in the front, 956 grafts into 1.1mm and 1.2mm incisions in the top and 300 grafts into 1.2mm incisions in the crown.

46 year old male 1 year post-op having received a total of 3219 grafts utilizing custom cut blades:

500 single grafts into 0.8mm incisions in the hair line, 1100 grafts into 1.1mm incisions in the front, 519 grafts into 1.1mm and 1.2mm incisions in the top and 1000 grafts into 1.2mm incisions in the crown.

41 year old male 1 year post-op having received a total of 1105 grafts utilizing custom cut blades:

500 single hair grafts into 0.8mm incisions in the hair line and 605 multiple hair grafts into 1.1mm incisions in the front.

56 year old male 1 year post-op having received a total of 2719 grafts utilizing custom cut blades:

500 single hair grafts into 0.8mm incisions in the hair line, 1,000 multiple hair grafts into 1.1mm incisions in the front, 519 multiple hair grafts into 1.2mm incisions in the top and 700 three and four hair grafts into 1.2mm incisions in the crown.

34 year old male 8 month post-op having received a total of 2007 grafts utilizing custom cut blades:

500 single hair grafts into 0.8mm incisions placed parallel (sagittal) in the hair line, 1,307 multiple hair grafts into 1.1mm incisions in the front, and 200 single hair grafts into 0.8mm incisions placed perpendicularly (coronal) in the temporal peaks.

34 year old male 8 month post-op having received a total of 2007 grafts utilizing custom cut blades:

500 single hair grafts into 0.8mm incisions placed parallel (sagittal) in the hair line, 1,307 multiple hair grafts into 1.1mm incisions in the front, and 200 single hair grafts into 0.8mm incisions placed perpendicularly (coronal) in the temporal peaks.

42 year old male 1 year post-op having received a total of 1649 grafts utilizing custom cut blades:

500 single hair grafts into 0.8mm incisions in the hair line, 1,000 multiple hair grafts into 1.1mm incisions in the front, and 149 multiple hair grafts into 1.2mm incisions in the top.

35 year old male 1 year post-op having received a total of 3034 grafts utilizing custom cut blades into a combination of lateral and sagital slits:

500 single hair grafts into 0.8mm incisions in the hair line, 1,000 multiple hair grafts into 1.1mm incisions in the front, 374 multiple hair grafts into 1.1mm incisions in the top and 1,000 three and four hair grafts into 1.2mm incisions in the crown.

39 year old male 1 year post-op after receiving a total of

1027 three and four hair family units placed into 1.2mm incisions using custom cut blades.

52 year old male 1 year post-op having received a total of 2627 grafts:

500 single hair grafts into 0.8mm incisions in the hair line, 1,000 multiple hair grafts into 1.1mm incisions in the front, 452 multiple hair grafts into 1.1mm incisions in the top and 675 into 1.2mm of three and four hair grafts, in the crown.

This patient is a 60 year old male 1 year post-op having received a total of 3066 grafts:

500 tailored single hair grafts into 0.8mm incisions in the hair line, 1,000 tailored multiple hair grafts into 1.1mm incisions in the front, 566 tailored multiple hair grafts into 1.2mm incisions in the top and 1,000 1.2mm tailored three and four hair grafts, in the crown.

53 year old patient received a total of 2375 grafts in one session: 100 single hair grafts in each temporal peak using 0.8mm, 90° custom blades; 475 single hair grafts into hairline using 0.8mm, 45° custom blades; 200 two hair grafts into each temporal region behind temporal peaks along with 1000 two & three hair grafts in frontal region behind the hairline using 1.1, 45° custom blades; and 300 three & four hair grafts into crown using 1.2, 45° custom blades.

Dr. Williams performed hair restoration on a 57 year old female. The pictures before hair restoration, immediately post-op and after one year are presented. The patient received a total of 2,608 grafts: 200 single hair grafts into 0.8 mm incisions in the hairline, 1,000 multiple hair grafts into 1.1 mm incisions in the front, 408 multiple hair grafts into 1.1 mm incisions in the top and 1,000 1.2 mm three and four hair grafts, 500 in the crown and 500 in the top.

41 year old male received 1562 grafts: 500 grafts in the hairline, 100 grafts in each temporal peak (coronal), and 862 grafts in the front.

Blade Size: 0.8mm for the hairline and temporal peaks and 1.1mm for the front.

Results at one year post op.

47 year old male received 2246 grafts: 425 grafts in the hairline, 100 grafts in each temporal peak (coronal), 1121 grafts on the front/top and 500 grafts in the crown.

Blade Size: 0.8mm for the hairline and temporal peaks, 1.1mm for the front/top and 1.2mm for the crown.

Results at one year post op.

bezane,

Thank you for your comments and I wish to answer your questions and speak to your concerns. I do all the transplants in my practice and have never had another doctor work for me in hair restoration. I have had many doctors wish to join my prctice, but I have refused taking on a physician employee or partner.

The locations in California are dermatology offices belonging to a physician patient of mine, who wants me to have the use of these offices for his referrals and other patients who do not wish to travel to Las Vegas for their transplants. It has become difficult for me to utilize these offices and these locations are no longer listed on my website. I had the use of a plane for awhile and it was possible to travel easily to these offices, but that situation is no longer available. My Las Vegas practice takes all my time now.

Unless I were to join other Coalition members in some sort of practice opportunity, I have no aspirations to become a "chain." My philosphy is quite simple. I, personally, visit every potential patient and answer their questions to the best of my knowledge, making every effort to clearly describe what I can accomplish for that particular patient. I guarantee a natural appearnace after the transplant has grown in, but I cannot always assure a patient that I can accomplish all the hair volume that he or she may expect with only one procedure. I accept full and total responsiblity for my technical staff and hold them to the highest standard. Oversite seems easier than it really is. For example, how tightly a graft (follicular unit) is held in the forceps by a particular technician or how hard the technician pushes the graft is difficult to assess. Moisture of a graft is critical, but how moist is moist enough to prevent injury is another example of a parameter that is extememely important but hard to measure or police. Ultimately, it boils down to the integrity, ethics, and quality of the doctor you place your trust in that he will staff his practice with the best help possible. Before a technician can be on my team, he or she must have many years of experience and excellent references from reputable hair restoration doctors. I have, often, flown technicians across country before I will use technicians available locally. Only the best technicians in the business can accomplish the ultra-dense packing. Every graft must, also, be prepared under steroscopic microscopes in my practice and this, too, requires special expertise.

The patient who posted his dissatisfaction regarding his hairline received my response. I merely tried to guess at a cause for the patient's area of poor growth discussed on the Forum. It may not have been any of the reasons I discussed, but I did what I felt necessary to prevent a similar occurrence by terminating the technician involved. Since I document who works where on my patients scalp, how many of each size grafts are prepared by each technician, and monitor every patients results, I can make a decision that I hope will prevent a similar occurrence. I, now, have hired a technician supervisor to assist me in evaluating the technicians work every minute of the procedure. This strict oversite will help me ensure the best work possible. Unfortunately, unlike when I was performing life and death surgeries on children, it's not all about me anymore, but about the team. It is not possible for the doctor to cut and place all the grafts for procedures that take 40+ "man hours" to perform. Those of us doing the best work must always remain diligent to each and every patient, but as long as there is the human element involved, mistakes may occur and corrections may be required. Another problem with evaluating your new staff is that it takes 8-12 months for a final result. Fortunately, my current staff members have been with me long enough that I know we are perfoming ultra-dense packing with excellent results. Your input is appreciated and I hope this clarifies your questions and concerns.

Thank you,

Joseph Williams, MD, FACS

Advanced Medical Hair Institute

Las Vegas, NV

drwilliams@need-hair.com

888-357-0888

To the participants of the Forum:

I am Joseph Williams, MD and I'm responding to the post placed by "Embarrased1" last week. I apologize for not immediately responding to my patient's concerns on this forum as it took me a short time to establish who this patient is. Since then I have had two detailed and productive conversations with the patient, one last Thursday and another one Friday. I believe that we have reached a resolution that is to his satisfaction.

While I would like to clarify my perspective regarding this situation and the above posts, ultimately I assume responsibility for all my patients' results and I do every thing possible to assure their satisfaction.

However, there were several inaccuracies, possibly due to miscommunications, in the above posts. One specific example, upon review of the chart, clearly establishes that there were no grafts placed in the crown. The 1200 grafts he referred to in his post were placed in the top region behind the hairline and front grafts. However, I would be equally furious if I were him and misunderstood this! Other things said in his post were very hurtful to me, but my last note in his chart clearly expressed my understanding of his dissatisfaction and my willingness to do whatever it takes to make him happy.

His hair transplant procedure was performed utilizing the most advanced techniques. Very small blades (0.7 mm) were used and the incisions were placed perpendicular (also referred to as coronal or lateral) so dense packing could be accomplished in the hairline. Although I had an experienced team, for some reason, many of the single follicular units at the hairline did not grow on the right side. This can occur from desiccation of the grafts, damage while dissecting them under the microscopes (trimming too close) or pressure on the bulb while placing them into the sites. The technician he speaks of in his post had over 10 years experience previous to being hired by me. However, despite this technician's extensive prior experience and positive references I did terminate his employment once I came to realize that his work was not consistently good.

I document the number of grafts and the exact location on the scalp where each technician works. This allows me to maintain quality control over every technician. Since I only perform one large procedure in any one day, I can and do oversee all the work. A large procedure, such as the one this patient received, takes about 40 "man hours" of effort. I do not leave the office and constantly observe the work of the team throughout the procedure. All hair transplant physicians require a team approach to accomplish these large sessions. I have excellent technicians and have stringent internal controls; however, if you are the patient with less than a satisfactory result, I understand that this is of little consolation.

In conclusion, I have had my medical doctorate for 30 years, practiced as a board certified specialty surgeon for 22 years, and have been a Fellow of the American College of Surgeons for 20 years. I have never had a law suit, in part, because I have always practiced with a keen sense of ethics, honesty toward my patients, while treating them the way I would want to be treated, and doing the best surgery possible.

Fortunately, my patients typically realize this and appreciate me for it. I am saddened by the comments made about me in the patient's post. But I must learn from it and prevent it from happening, again. Every patient of mine receives my personal cell phone number and my home phone is listed in the telephone book.

I apologize to this patient and to the Coalition members for this unfortunate occurrence. It is apparent to me that many patients have been treated poorly in hair transplant practices. But I know that the mission of the Coalition of Independent Hair Restoration Physicians and its members is to provide patients with the best results and satisfaction possible. I am honored to be among them and I intend to do my very best to respect its membership standards.

Since the "questionable" technician was terminated, I have carefully assembled the most capable technicians available. I have in place a Technician Supervisor, whose responsibilities include assisting me in oversight of the procedure. He has eleven years experience, extraordinary abilities, and shares my commitment to provide the best hair transplant results available anywhere. He and I inspect the quality of all technicians' work. This includes microscopic preparation of grafts, care of grafts regarding desiccation, proper handling and placement of the grafts. The performance of all my technicians under my new "quality assurance" system has resulted in accountability leading to consistent, high quality transplants. I assure you, my work is routinely excellent.

I can't always explain an occasional mediocre or rare poor result. But I can correct it at no charge or "make it right" and assist the patient in finding another physician, if he is uncomfortable with me. I hope this response helps clear up my position in this matter.

Sincerely,

Joseph L. Williams, MD, FACS