Zup

To the contrary, first and we hope all would know this, we simply would never post a result with a concealer. Our objective to our posts is to shown what one can achieve with a given amount of hair, of certain hair characteristics in a given area. The difference in the hair on the sides VS the top, is not that the top is thicker from a concealer, it is, at 9mths, it is not as thick as the hair on the sides. From a top view taken at a 90angle with the scalp the light will pass through the hair and pick up more scalp, even when it is pretty hidden in person. Where the hair up high on the sides is normal density and the acute shingling on the vertical side plane makes the hair appear even more dense. Janna’s off to Europe, so I am chipping in.

Dr Ron Shapiro, speaks very highly in regard to Dr Lorenzo from Spain. In discussing FUE techniques with Dr Shapiro myself, he references Dr Lorenzo frequently regarding his technical skill and approach. In pursuing FUE ourselves, 4 years ago, Dr Shapiro reached out to pick the brain of a number of his colleagues he admired and respected, in developing our approach at SMG. Dr Lorenzo along with a few others have had much impact on the quality of our FUE work today. Regards

Newguy28, Regardless, of the technique.....you need to be very careful!!!!! You are only 28, with signs of extensive hair loss. You are close to being completely bald on top, with the sides and back receding down from the top plane of your head. The biggest concern is progressing in time to a type 7, who’s donor shrinks up in every direction; downward from the top, inward from the sides, upward from the bottom and extreme thinning within the donor. I hope this is not the case, but the problem is no one knows. No one has a crystal ball, and when dealing with a moving field, limited source you need to prepare for worse case scenario not best case scenario, especially when the signs stack up against you. Donor can thin on everyone over time and more with men that have extensive hair loss. Have you seen men in their 70's where the hair on the sides and back have receded in every direction, and only a 1 inch fringe remains that is see through? In regard to procedures, strip will be more productive, but leave a fine linear scar in the right hands, that short hair can hide fairly well. But, if the donor can becomes see-through there is a physiological concern. FUE, could allow you to establish some frontal presents, but at 28 is that enough. Regardless of the procedure, aside from what i mentioned above, you need to go into transplantation, as if you can only cover the frontal third or half and not the crown, if you can do anything with the crown it is a bonus, such as shrinking or a thin film of coverage. We are not involved with hair system but they have come a long ways, and if full coverage is what you are looking for at 28, you may want to at least look into them. You can always contact me at our office to discuss this in more detail. Now, this is only based on one photo, the main point is to not rush out and jump into this.

Hello Chris I understand your initial concerns of wanting to speak with the doctor and not go through the consultant, I personally would feel the same way. Dr Shapiro would be happy to speak with you specifically, however, we have set up a protocol to provide the best over all service for the inquiring patient and the office. It is very helpful that the doctor is aware that the patient has a strong understanding of the procedure and the principles of transplantation, prior to speaking with them. I am available to provide that undividied attention, where it is very difficult for the doctor, with procedures that last 8-10 hours. We can move through this fairly quickly. From there a phone or in house appointment, with the doctor can be set up. This process has worked fairly well over the last 22 years. Whatever you chose to do is fine, there are other fine physicians in the industry. Regards, and Merry Christmas Matt

Hi All, I 100% agree with you....Joe's Excellent!!!!! Joe's help on the internet has been exceptional, unmatched. Matt Zupan

Aaron, Eventhough you are fairly young, and could progress quite a bit, especially if you did not use Meds. Your donor, is fairly good in density and characteristics and the sides don't seem to be at jeapordy of spiralling out of control. I believe you could address those areas, but no need to be aggressive. The left side, actaully looks fine, nothing more then and a little strengthening, and bringing out the tip. Then adjust the right side with it. It is only if you really wanted to, we would be receptive, otherwise there is no need. Yours temporal peaks are there, and still come out.

By the way I think Joe’s, lateral sides look prefect, just right! Very balanced with the position of the hairline and temporal corners, right amount of definition and of course natural. His entire hair line from ear around to the other ear; is nicely balanced in regard to the density and coverage that’s on top of his head. This is a look you would fine in nature, with someone who has not done a transplant, but thinned a bit in the crown and has good moderate density in the front, but not quite normal density. Now, if Joe 10-12 years ago would have created a more aggressive anterior border, I don't believe the balance and naturalness would be the same. This has been well planned out....

Hairthere, I myself am very picky and particular, and I am a fan of them, they enhance and are part of framing the face as much as the hairline that runs horizon across the forehead. Some of what I am saying, is when to do them, and the possible risks associated. And, if a patient can be built back to a full head of hair and maintain that over time, temporal peaks should be included. So your latter scenic with the patient with a low, strong hairline (most likely a full head of hair behind the hair line) and no temporal peaks, build them up. There are always exceptions but of patient I've seen, the more progressive the hairloss type 6-7, from the temporal peak to the temporal corner this area can recede extensively, at almost a 45% angle back. One can be in store for a lot of work and back fill, to establish this fame, which may not leave a ton of hair for the posterior region. And, now what one has is a front border around his face that implies, his patient has a full head of hair, but sports a bald crown the size of a grapefruit, not generally seen in nature. All i am saying is just be careful and one needs to think about these things in planning and doing transplants. What i have found is hairlines, generally, (i sure there are exceptions) the stronger the anterior border, the fuller head of hair behind it. As, men thin and progress that border weakens accordingly. All iam saying is one needs to be a little careful, in planning, but if you are a good candidate, add THEM.

corvetester, -temporal peaks are great, and accent the face and you will usually find them on men with full heads of hair. The concern is in building them out you are using hair technically outside the MPA, and if the side recede further in time, one is obligated to back fill the area out of necessity, using up more grafts. Ironically the patients that generally loss them are patients that generally have more extensive hair loss, where the need for hair may be more important elsewhere. If the patient can maintain a full head of hair things work out fine, but it the patient, runs out of grafts and has a bald crown the work can look a little top heavy and a bit peculiar. Fortunately, they don't generally require a ton of hair, these areas just need to be established to fame the face, high density is not necessary. Joe, it your turn....Zup

Joe, I get it!!! You are a witty guy. The first paragragh made me a bit nervous, and the picture of me on the Ultimate field with my cap, could very well pass for America's Most wanted. And, kudos to you for all your many contributions to this industry. Regards, Matt

Well, thanks you for your support, many of you, that’s very nice. Sometimes it is hard to be diplomatic, and on a rare occasion with a strong patient, things are taken and go wrong. Yes, with in my consultation, I will touch on our clinics credentials, which I would think every patient would want a sense of.....I would. Then I get into education, which some patients feel they know already and don't always want to hear. I do respect these other doctors and do know them, these names mentioned simply are the best, and consistently produce the high quality results in the business, out of nearly a 1000 doctors in our profession. However, there are times, in explaining differences in philosophy and our approach, I can get adamant about going to low, broad and strong. The concerns about being too aggressive along the anterior border. Patients for years and picky patients and knowledgeable patients have sought us out for great, natural looking hairlines. And, sometimes there is a face off. I can come up with many accuses, but bottom line...sometimes I am not that SWEET, I wish I was, but the tone with the patient goes down the wrong path. I've done these appointments for 21 years, and only for SMG, and have been with Dr Shapiro from the beginning. I like to be a great representative for both Dr Ron and Paul Shapiro, because they both deserve it. I try to make my consults, primarily educational in explaining the procedure and the principles of Hair Transplantation. I have no interest in being a salesman, but I may stress the facts. Fortunately, we are always busy and the need to sale is not there. I feel very comfortable to say, to a potential patient, for him to feel assured, there is no one in the industry that can do anything better than us, but a few can match us. And, then I try to support this so they can come up with the same conclusion. I am very aware, H&W and Rahal, have their loyal patients that are very defensive if they hear something negative about them; I applaud you. Both these groups, from the inside scene, are the BEST, and that won't change. I am passionate, and a bit prideful I guess of our clinic, I am sorry, sometimes I get a little over zealous. This industry can be a crap shoot, and I know that patients that go to these doctors and a modest number of others are going to get there goals meet and be happy. The one thing I hope is, that the patients that have been to our clinic, feel I never BS them, and that nearly, if not everything I said, was in-line with what they would experience and they were not miss lead. Sorry Josh, for taking over that phone consultation....Matt Zupan

Funny Aaron.... I am going to go back in hiding!!!!

I caught this, so I thought I would jump in an answer..... I feel routinely we meet our patients goals with densities, of 25fus/cm2 in the back two-thirds of the male pattern area (and, we can physically transplant densities of 20-80, but it is a matter of WHEN, WHERE, WHY, rarely is there is a need for 60plus, if ever) . For some men their not even concerned with that area. Even the one that are, they don't have the highest expectation and they shouldn’t; do to the ultimate cosmetic significance of this area compared to the front and the need to prioritize where we use this limit donor now and down the road . All that many patients care about is just enough hair to hide the scalp, anything more does not appear much different, so it is waste. I know from the internet, 25fus\cm2 doesn’t come across as much, but is a quart of original density, which can create a foundation and provide just enough hair to hide the scalp. And, for any patient who has a moderately strong possibility to bald, that may be all that may be able to be allocated there. With the average donor yielding on the average 4000-8000fus moderate be 6000, average MPA (200cm2).....yielding 40fus in the front 100cm2 and 20 in the back 100cm2. Like always, Propecia which I believe he started at the same time, stimulated miniaturized hairs, and I believe all and all the patient had good hair characteristics, with no characteristic that hurt him. One last thing, good growth- high yield, if 25fus/cm2 all grow the results look better than if only 70% only grow.

Hey Troy, your fine....I did not want to stop anything, I apologize to Dr Alexander who is in the middle of this. I just wanted to clearly describe our surgery and Dr Shapiro involvement so others were aware and knew exactly how things were done. Everything else is good. Regards, Matt

Try Polamalu, I think you made a fine choice, I don't recall who you are with the information above, but I am sure Dr Alexander will take good care of you. Just to clarify for our readers: I would never imply the doctor does every aspect of the work, but if you speak with any of our patients they will tell you Dr Shapiro could not be more in tuned with the patient and the procedure, it is his nature. He is in the surgery the first half of the day 100% of the time. At noon-1pm, when the patient has his lunch, all the incisions have been made, which the doctor does. The incisions the doctor makes, dictate, pattern, distribution, where certain hairs go, basically the artistry and angle and direction in which the hair grows out. After lunch there is a window where the doctor does not need to be in the surgery room the entire time, this is when the grafts are generally being placed behind the hairline in the core area, by senior techs that have been with us up to 15years. Placing grafts is like placing a letter into an envelope, which does require a gentle touch to not damage the graft. With years of experience and repetition our techs have become highly skilled at this, however, our techs do not make a move on their own, Dr Shapiro orchestrate everything and inspects every move. This is a 2 hour window where the doctor can step out of surgery and see a patient in a consult for a short period of time. Once the grafts in the core area have been placed, the doctor with the aid of a senior tech, will work along the hairline with the last 10-15% of the grafts (the finest 1-2 hairs), providing 2-3 passes to tweak and fine tune the hairline. Away to explain this would be, the area behind the hairline, is like painting the center of a wall, and the work on the hairline the trim work, requiring more precision. The multiple passes is like writing a paper. You write one draft, re-read it, tweak it, write a second draft, read it, tweak it, to achieve the very best end result. At our clinic our doctors are involved with the whole procedure and are in the surgery room 80% of the day. Hope this helps...Matt

I agree, Dr Konior....has what you look for in a transplant physician. High quality, consistent results, and doing what is appropiate for the patient. Dr Shapiro and Dr Konior have strong mutual respect for each other. It comforting when you know that the doctor you've chosen will guide you though all this and as long as he is in your corner you will be well cared for.

What Joe has said is correct!!!! We have discussed this and will continue to correspond with regard to patients that bid us against each other. Patients who assume we resent each other’s clinic, we do not, we all know each other and are aware we are all able to satisfy our patients on a very consist basis. There should be plenty of data for anyone researching, that they can pretty much go with anyone of the three clinics and feel their goals should be met, if realistic. In addition to many others in the profession. There is very mediocre work being done in our industry and there has always been, one needs to research and find clinics that possess the skill, technique, and strong quality control, once you have, you have found the “best”. There are many that do this. There is approx. 900 hair transplant doctors in the industry, worldwide, one cannot believe there is not more than one clinic that is capable of creating awesome amazing work. There are different approaches and overall philosophies which may or may not matter in the long run. Clinics can agree to disagree with various approaches and still make the majority of their patients tickled with the results. It is funny how so many patients that have had work by different doctors feel their doctor is the best. How could they be the best if the other doctor is the best. It is possible to have more than one "best", there are, in many industries. I believe SMG is one of the best, but I believe that H&W as well as Rahal are also, because they bring the right ingredients to the table that has consistently satisfied their patients. The unfortunate thing is, patients that conduct their research in this manner may push some of the best clinics away from them, in that, some patients may be tagged as difficult. I understand, however, research also for some becomes a mission consuming ones time and life; it is critical they make the right decision and rightfully so. One because it is a lot of money, two it deals with your appearance and three the stigma of bad transplants. I just spent three years researching custom frame road bikes, which at the end I feel I purchased the "BEST", but there are about 5 others that many believe are just as good. Regards, Matt Zupan

Takingtheplunge, You said it well, Happy Thanksgiving!!!!! To all.... Thanks for your respect and trust, like many others we will continue to do what we love, which is to serve you with quality and care. From all of us at Shapiro Medical

Hello All, As far as predictability of future progression, if the pattern is at all unknown, one needs to plan the patient as if they may progress to a type 6-7 pattern and stay within the defined safe zone. If there is very little sign of progressing to a type 7 one may find it is worth the risk and use much of the side planes, but still understand the need to stay lower in the back. On type 6 patterned the sides are retained high while the posterior area on the crown can recede lower. Many times there are strong signs of demarcation where hair is miniaturizing. Generally any young patient thinning (in your 20’s) should always be address as if they are going to progress to a 6-7. The tendency is when one starts thinning in there 20’s it is a strong indicator that the hair loss may be more extensive and progress faster. So until one shows they won’t progress to extensive loss we need to address them as if they will. However, if ones on meds this may mask the problem as someone else mentioned. And, some patients may be inclined to take a calculated risk to work outside or on the border to increase their donor source or pick up a few fine hairs for the hairline. Now, in regard to yield with FUE, and this is what caught my attention to this thread. I would say survival is on the average lower then 90-95%. I believe at the leading clinics with strip today waste with dissection is approx. about 5%, survival of the 95% that is transplanted approx. 90-100%. While, FUE with a skilled extractor the transection can be quite low again maybe only 5%, but the survival of what is transplant without transection is more like 75-100%. We believe even if the graft has been dissected cleanly as Dr Feller mentioned, the means of extraction even when there is no transection: torsion, traction and compression are still placed on the graft. Plus, the unit alone is a more delicate unit and not as hearty as strip graft. Focus, patiants and skill of the extraction minimizes these fore mentioned forces but they are still present. FUT, did not have the most desirable survival in its infancy either until doctors recognized it was an all in all, a more delicate procedure and were required to change their protocol round it; in regard to greater detail, stronger instrumentation, proper number of techs and increase hand eye coordination with techs. Today the procedure is quite consistent in the hands of many physicians. We feel FUE can possibly be the same and the yield may become as reliable but today it is not quite there on a consistent level. This seems to be the overall census from many of the recognizes physicians Dr Shapiro knows and respects from around the world that possess the greatest experience with FUE. Much of this feedback was gather as resent as a month ago attending our industry’s largest International Conf. in Boston. Happy Thanksgiving, Matt

Here is our take…. Hairlines are in complement with how much hairs behind them, if one has a strong transitional zone and one progresses to bald and they do not reestablish full coverage with an appearance of fullness the hairline in time may look peculiar. It is a trait, that represents a full head of hair and generally only found on adolescent kids or men that have bucked the system and maintained a full head of hair. In regard to nature, heads of hair are like bodies of water along the shore line the water is shallow as you move into the water the water gets deeper. This is similar to a head of hair along the hair line, and this is around the entire head, the density is less and made up of more 1-2hairFUs as you move into the hair the density increases and there are more 3-4 hairFUs. At our clinic, if a patient has a high potential to maintain a full head of hair the transition zone will be more narrow, if the hairline is on a patient with more thinning the transition zone will be deeper. Our hairlines have two zones a transition zone; made up of all ones hairs, irregularity and in the pockets of irregularity, various degrees of densities. So nothing to consistent. One doesn’t want a perfect hairline, one wants perfect imperfection. Behind the transition zone is a Defined Zone made up of 1-2 hairs planted generally as close as possible. For years we have dealt with patients that want the most natural, along with full hairline, in establishing the fullness we build a hairline to approx. 40-50fus generally (Defined Zone)and build a strong front core, the foundation to the front, this will block the light and make the hairline look fuller, while following nature. After establishing a hairline at 40-50FUs if the patient is interested in greater density we generally are not packing the hairline with more hair, we are building more density behind the hairline. If one packs a hairline and the frontal core is thin the hairline will appear see through. The same as if you were looking into a forest, if there are twenty rows of trees densely packed but an open prairie behind it, one will see through the trees and see light. If the hairline is established and the frontal core is thick, the hairline will appear full. With corrective work we’ve done on patients over the years, especially with old work, the hairline was packed with hair, with less density behind it and when the hair is wet and many times even when it wasn’t, the hairline appeared as a speed bump. We would call it ring around the hairline, and we would thin out the hairline and build the density behind it to improve the appearance. Side note: I agree with Mahhong’s evaluation, over the last 20 years I have found people look at themselves as made up of parts and they critic every part individually, others view them as a whole, and many times even with hair loss and receded hairlines, the whole looks pretty good, even though, there may be many imperfections with each part the total combined looked good and attractive. Regards, Matt Zupan

weweregods, I'll support the kudos from Dr Charles and spex.... from Dr Charles, Feller, SMG not bad. It is important to plan densities around where one will progress too, at SMG, we evaluate our approach around where the patient is, at the moment, but because we are dealing with a moving field and a limited source we also want them to understand what can be achieved worst case scenario, if they progress and go bald. If the average patient goes bald; average patient has approx. 4000-8000fus in your donor to move, moderate being 6000fus. At our clinic we've been measuring MPA areas for years and we have found average MPA (the top plane of the head) is approx. 200cm2 in surface area. If you distribute 6000fus over a 200cm2 area, the density yields 30fus/cm2. 30fus/cm2 is a density that may have a fuller appearance depending on the characteristics of the hair, so 30 is not bad for someone who would be otherwise bald. Now, how most patients would distribute the hair would be rather then 30fus/cm2 over the entire area evenly and treating everything equal, most would prefer 40fus/cm2 in the frontal half (front 100cm2), a fuller appearance and 20fus/cm2 in the crown (back 100cm2), generally just enough hair to hide the scalp when dry. Now, as Dr Charles mentioned there is what is called selective distribution; which is by making certain areas thicker you'll make other areas around it appear fuller. Two particular areas: are the frontal core area and anterior crown. By making the frontal core thicker it will make the hairline and everything around it appear thicker, by blocking the light. And, because the crown sit on a slope the hair falls downward, by making the anterior crown thicker, there is more hair to shingle over the remain crown area. So, if you are an average patient and you show a strong disposition to progress and go bald, and have an interest for complete coverage, one should not exceed these designated densities. If one is not concerned with a bald crown or can be assured they won't go bald either do to genetic predisposition or that meds will prevent it (but this can never to confirmed for sure) higher densities can be achieved. Regards, Matt Zupan

Vancouver what a finale; Canada vs USA in Hockey! Showcasing one of the most exciting athletic sports on the planet. Being from a state that has a little Canadian in them, Minnesota and having played hockey myself starting from the age 5, it was tough to lose, but the closing ceremonies otherwise just would not have been the same....I think it was the polite thing to do. Regarding a fellow Canadian patient I've been emailing, I made a wager a 100grafts free if they would let us win; I guess his answer is, he would rather pay. Hockey at its FINEST, very proud of both teams- AWSOME GAME- AWSOME GAMES

Nice job Dr Haber....from your fans at Shapiro Medical

Having meet Dr Reed and knowing the respect Dr Shapiro has for him....patients on the West Coast should always at least consider him. This example is a strong indication of why....Regards, Matt

Determining density yourself can be a little tricky...you can not see it and you have nothing to compare it to. We can take magnified photos of the donor and count them. To just get a sense of the estimated density we eye it and from evaluating many patients over the years we can tell if it is low, moderate or high, just by eyeing how close the hairs are together. Sometimes patients with course hair think they have high density because it seems like a lot and patients with fine hair have low density, it is not the case. Density is how much hair in a sq cm, whether it is coarse or fine. Added point, density determines how much hair a patient ultimately has to move (number wise) and characteristics such as color, coarseness, wavy and stiffness determine the effectiveness of the hair when moved.