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Zup

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Everything posted by Zup

  1. Based on many previous patients, the amount of surface area and some strong hair in the frontal core. I think this patient could get his goal meet with 2500FU....3000max if he shaves the hair. I would like to add, based on his thinning, the degree of miniaturization and the side recession there are enough signs frosty could have extensive hair loss ahead, therefore, a need to monitor his use of donor and use no more hair then necessary to meet his goals. Meds should be a must. And, some caution on building out the sides in that they may recede further and you'll be obligated in doing more work to back fill them.
  2. To add a bit more detail on this topic. At SMG we assess patients with where their hair loss is when we see them, but because we are dealing with a limited source and moving field and unknowns we always educate them on the worse case scenario and what is achievable if they progress and go bald. We base this on what the average patient has opposed to what an above average patient has. Average patient has approximately 4000-8000FUs in their donor....moderate being approximately 6000FUs, average Male Pattern Area is approx 200sqcm. Assume, an average patient progresses and goes bald. One takes 6000FUs and distributes them over a 200sqcm area, it yields 30FUs/sqcm, what is 30FU/sqcm, depending on the characteristics of ones hair 30 can be the low end where things have a fuller appearance. Not bad for someone who would otherwise be bald. Now how most people would distribute it would be, rather then treating everything equal most would rather have the front 100sqcm fuller, close to the appearance of normal density and the crown just enough hair to hide the scalp. Now to get a bit more precise with selective distribution, rather then 40FUs evenly through the front, we would establish a strong and natural hairline at a density of approximately 35 and the core approx 45. Many build and create more density at the hairline and fade back. Well normally heads of hair are like bodies of water, along the lake shore the water is shallow and as you move in the water gets deeper. By establishing the hairline with good substance, but not a wall, and then building density in the core this will make the hairline itself appear much thicker. Similar to a forest, if there are 20 rows of thick trees and an open prairie behind it you will see light through the trees. By having a thick core behind the hairline it blocks the light making the hairline appear thick. In the crown rather then 20FU/sqcm uniformly through out, we treat the crown as if it is made up of thirds; top, mid and bottom and because it sit on a slope we establish a higher density in the top third approx 30FUs, 20 FUs in the mid third and 10Fus in the bottom third, in that everything up high will shingle downward over the areas below. Another issue with the crown is one needs to be a bit careful with the bottom border because that is the area that will potentially recede further in time. So overall summary, 30FUs through out or 40FUs front half and 20FUs in the crown....further break down of distribution in the front 100sqcm, 35FUs hairline 45FUs frontal core and in the crown (the back 100sqcm) a 30, 20, 10 distribution. Now this is all based on average patient that progresses and goes bald or may go bald. If one does not go bald or has above average donor more can be achieved.
  3. We are not technically so conservative. I would say we are very analytical, and our philosophy is to do what is appropriate for the patient both now and down the road. We are happy to pull no punches on the appropriate patient....low, broad, thick hairlines, extreme densities, aggressive crown work, build up lateral sides, and do the largest session possible on the appropriate patient. A concern is the FUTURE, all info shows the younger the patient starts thinning the more extensive generally the hair loss and the faster they progress. The problem with many young patients are they don't just want a hairline that looks natural, they want the hairline they are use to having 20 years of their 21 year old life and what the peers have...this make sense, we understand that. However, these are hairlines that possess all the extreme traits. There is nothing more we would love to give them, unless it could hurt them in time. If so, we have done them no favors. Ironically young patients are the last patient you want to be to aggressive on. I"ve heard patients say well I'll accept a bald crown in time to have a low, broad, strong hairline now. The problem is a bald crown on someone with a low, broad, strong hairline will look peculiar. Generally these aggressive hairlines are only found on men that maintain a full head of hair. The young patient thinning is the least likely to maintain a full head a hair their entire life. Hairlines should be mapped out using measurements, facial structural landmarks and using patient's hair as a guide...along with taking into account age, what the patient has already loss, the amount of miniaturized hair, characteristics of donor, whether the patient is on meds and family history. These are things Dr Shapiro has taught and lectured on over 12years, at conference all over the world.
  4. You guys type way to fast...my head is spinning. We're happy to respond, which we will??¦.powerful stuff on here. Have not read everything...We will definitely add more to this, not so much as to- who is right or wrong. Emperor, we are well equipped...no one ever has implied our work is not natural enough and we embrace all those 3-4FUs in their entirety and by no means do they affect naturalness as long as they are placed in the right areas. Smaller is not better when it comes to pure FUs, a 3-4FU is a pure as a 1-2 hair FU, Mother Nature found it adequate.
  5. Thanks Thanatopsis_awry...for recognizing Dr Shapiro's commitment to excellence... I agree with everyone's wait and see attitude with FUE. We have taken it slow and cautious not to get a head of ourselves, but we are building up steam and feel very confident with what we have done up to this point. We will follow these patients closely and keep you all updated. Many patients have contacted us in pursuit of FUE at this time we are only allowing one a week, to assure the utmost personal attention.
  6. I agree no need to count Dr Wong out with hairlines....at the same time please do not assume Dr Shapiro on the appropriate patient, type 6-7 can not yield as many grafts as any physician can safely. The donor is a fixed area; one can only go so long with a strip and wide with a strip safely and entrap as much hair with in that strip as possible. The different at best would be possibly 5% in hair count, in that Dr Shapiro may not take it to the brink where he's concerned increase risk can occur in order to yield a few more hairs. Both clinics understand these principles.....Best of Luck
  7. My apologizes, thanks for making me accountable. I thought it was a strong bench mark, to allow others a bit more confident in what can be done. Looks, attractiveness, concerns are all subjective and relative. ....Generally, eyebrow work is hair from the head and that is one of the issues....in that it has a longer growth cycle and will need to be trimmed. Thanks, Jacky
  8. We have not necessarily pursued eyebrow work, but have done our share. Like corrective work no one so much specializes, but the doctors that are equipped to provide some of the most refined work would be docs to contact and consider, in that what corrective work, eyebrows, hairlines have in common is refinement artistic approach. Of the women we have worked on, all seem to be extremely attractive and very particular with not a huge problem. They just wanted the ideal eyebrows to polish off their look, because there are a few issues with doing eyebrows and these patients being so particular and attractive we were a bit nervous, but they all have been extremely happy, which makes me believe if their happy anyone would be happy.
  9. The exception is, you just started propecia (I would strongly consider Rog Foam, too...yes in the front as well as crown)it take ultimately 2years to achieve what you are going to achieve, in regard to retention and thickening of miniaturized hair. Which, if you could keep and enhance all the hair that's there, it may surprise you cosmetically and meet your goals. You may have 40fus/cm2 in your core, of many 3hair groupings, but it looks approx like 10-15 due to the miniaturization of the hair, if you could keep those hairs, increase diameter and make them look like a true 40FU/cm2 the core may be sufficient 40FUs is good, many times. And, you are then left with simply, resolving the hairline zone, which could be serving with approx 1500FUs,... the hairline area is approx 40cm2, transplant 40fus/cm2...1600gr. Hairline work based on age, approx 1500-1800 possibly up to 2000gr, be nervous to do much more, at this time. Now, if you had already been on Propecia & Rog for more then 2-3 years and we knew things were not going to get any better, I would clearly say whole front third. Best to cut hair in core, not require, but possibly optimal, in order to best work down between fine miniaturized hairs that are very close. Transplant based on available space approx 2500gr. Dr Shapiro would probably consent to either approaches. There can be two sides to the approach, there's always alot to consider and evalute. 1500-2500plus...FUs Front third
  10. Repair Guy, things look very good, you will have a great result, most important natural and you are already well on your way at 4.5 mths. .....Excising the hairline and removing that entire mess within it was the KEY; big grafts, cobble stoning, scarring, pitting even in the best of hands one could not have hidden this. With it removed and Dr Hasson in charge of re- establishing the front in the way it should have been done in the first place, you'll have the freedom to live your life again. What a please of mind.
  11. Hello mmhce, you may have had this answered, but the answer is yes, they are made in the morning the day of surgery....not prior
  12. This is true, H&W worked with a medical supply group and invented the blade cutting device approx 5-6 years ago....Dr John Cole was one of the first to start using custom made blades. Each day for every patient the blades are made in relationship to the size of the patient's individual grafts to provide a custom fit. It has been a excellent addition in bring this procedure, in the hands of the industry leaders to an end point....once we are down to a trimmed FU, in the hands of skilled techs and proper magnification there is nothing smaller and more refined to go too (this is an end point). If we can't make the graft any smaller and the incision is made in relationship to the graft we can not made the incision any smaller either this also is an end point. What this ultimately means is it is refined to the Nth most degree...good to know, right. What this means to the patient is the smaller the unit, the smaller the incision the closer we can place the grafts, which is important both with aesthetics and density. Similar to rocks in a jar versus sand in a jar, the sands will be packed closer.
  13. Couple things: in your immediate post-op photos the work looks nice, very clean, no red flags of bad work. It is hard to determine from the immediate post-op, the angle of the transplantation, there is not much length to the hair, even the results a year and half later do not show the mal direction, so much. I am starting to think that the transplanted hair taken from the back simply has a wave that the native hair in front never had, and this is frustrating you when you try to groom your hair, in that you have very little control and it is not styling the way you want. If there are mal- directed hairs they can be punch out, hopefully there isn't many. In many cases, it is not necessary to punch them all out anyways, just the most anterior ones, the harshest ones based on size and severity of angle....simply the one that draw the most attention. Usually it is then necessary to do a little more work around it, that is consistent in angle to overwhelm them and blend properly. Last, I am curious about the red dot on the hair line a year and half later?
  14. Hello ZXCV, Sorry to hear about your experience. First off, in what regard did the procedure go, really bad? Poor and irregular growth, larger grafts on the hairline, mal direction of the hair, hairline to low, pitting, poor spacing...please provide detail of your specific concerns. Laser hair removal is one way to try to remove poor work, as you indicated you unfortunately loss the hair that you paid to have transplanted, along with losing a percentage of your precious limited source. Just yesterday, we did actually what you are inquiring about; we punched out old FUE units on a patient's hairline and moved them (therefore utilizing the hair and not wasting it). While also doing more FUE to enhance and improve the area. It may be possible, that no corrective work is necessary and all one needs to do is more work to hide it and the previous work will serve simply as added density. In this case, one can turn "foe in to friend".....Photos would be helpful.
  15. careabouthair, We know Dr Devorye very well, his techique is state of art in regard to instructmentation and detail, he hosted a major conference last year and displayed his work with a live surgery. If you consult with him and you like what he has to show you, what he has to say and your comfortable, I would say you could stay put in the UK and feel confident with his work. And, mention Shapiro Medical says, Hi...REgards, Matt
  16. Hello Careabouthair, First, in that hair loss does not discriminate, every patient reports back somewhere after doing this procedure and keeping it quiet is not unique to you. You will not need to cut your hair, you are clearly thin enough to work down betweeen the hair no differently then if we were to shaved it, the space is sufficent. If your self concious, which again most people are, you are not the exception. You take off approximately 7-10days you should be fine. The first week it looks like a crew cut with a rash, but very clean, at 6 days with shampoo on the scalp you can start with mild pressure rubbing in a circular motion this will generally take off approx a third of the debris a day, usually by 9 days nothing look surgerical and you can wean back into work. In your case, in that you would not need to shave, you could comb the hair forward and be in pretty good shape. In general, anyone persuing transplantation should always prepare for more work. You can hope you don't need more work and do things to hedge (use meds to work against progression and do as much work as you can safely per session) against more work, but you always need to prepare as if you may need more and if you don't that's great. In your case because you are thin enough to distrubute through at least the whole front half, if you did go on to lose all the rest of your native hair the work could stand on its own. It would look as if you just went bald on your crown and retained hair in the front, this is a natural pattern that occurs in nature. You may not like this pattern, but it is natural. You would not need more work, but you may want it...it would be your choice. Last, because of your age and the possibly to have excessive hair loss, in that this is common with men that start thinning young. I would be a bit cautious in being to aggressive with your donor...3000FUs would provide a night and day change from what you have now. You would move from no frontal foundation to an establish frontal foundation, with nice shape, structure, symetry, a uniform foundation that will hide the scalp and an established hairline that would frame the face. You can allows beef it up a little more, with out using anymore hair then you have too. Don't get a head of your self. I use an anlogy: in a third world country their not looking for the BIG SCREEN TV, they want food, shelter and clothing. When you don't even has a base or a foundation, don't think about maxing out and pulling out all the stops. As much as we would love to get you back hair for hair to where you were before thinning, because of the major valuables this is not feaible. So the objective is to achieve a result that looks natural now and down the road and prevent you from ever looking bald, because that very likely is the alternative??¦.Regards
  17. mmhce, "I can't see you now just your two eyes", but thank you. I'll introduce myself; I have been with Dr Ron Shapiro ever since he has been doing Transplants, starting back in 1990. In the past I was not interested in posting or trespass in your world. I thought this would be a venue where patients could be left to them selves to discuss matters and if they wanted the opinion of a clinic they would contact them. I've started to wet my lips a bit, and so far I enjoy it. Thanks, Matt
  18. Hello Chops, most type 7s are dealt a double whammy...they have a larger balding area and many times, poor donor to serve it. Type 7 patterns receed into the side and back planes of your head and the donor can erode downward, upward from the nape and in from the sides...along with, within the donor. If you have the potential to be a type 7th even if you are not now, you need to address yourself that way now and if you can prevent it with meds you can get more aggressive in time, but only when you know for sure. Most type 7 should not get to aggressive with the anterior or posterior borders; the work usually needs to be balanced on top of the head, like balancing a book, not too weighted in the front or the back. Therefore, the end result would be a higher more narrow hairline and a bald crown. Type 6 patients even though bald, many times have great donor and can achieve full coverage in most cases. Average patient have 6000FUs in the donor, average MPA is approx 200cm2, one distributes 6000FUs over a 200 cm2 area it yields 30FUs/cm2, not bad for someone who would otherwise be bald. 30FU/cm2 depending on the characteristics of ones hair; color, coarseness and wavy can have a bit of a fuller appearance, in my opinion most patients would rather have the frontal half, average 40FU/cm2 the crown just enough hair to hide the scalp at about 20FU/cm2. All the Best, Matt
  19. Hello JK111, please don't worry yourself sick, this work is OK, you'll most likely just need more. It will not look unnatural or require corrective work...just more, which is the case for many patients in that goals are subjective. There are many fine physicians that would be able to take over at that point if there is a need and blend a second procedure down between it like a bed of nail and transform it into a result that would be no different then if you went to them in the first place. This work will not ultimately hurt you in the long run....Regards, Matt
  20. First off, I agree with Latinlotus...unless you take photos you will not have a true scope of what Propecia is doing. I have had patients that swear that they have progressed over the course of the first year of using Propecia. When we take photos to compare it is evident things have thicken. I would strongly recommend adding Rogaine Foam if you want the best and safest arsenal (Avodart ??“ potential for greater side effects) and understand it takes up to two years to see ultimately how you are responding to the meds. With Merck's clinical studies taking photos every six months showed that in many case things did not start to change until a year. Proper expectations also need to be in line, which are to maintain and thicken hair that is miniaturizing and not with expectations of re growth. If you get re growth chalk it up as bonus, however, if anything can grow hair back these two meds can, especially together. Even with no re growth these meds can improve your condition. Re growth is great, however, simple math shows if you double the diameter of a hair it does 4 time more then adding a hair of the same quality. So, if you have hair that has miniaturized to half its diameter and you can bring it back, it will bolster things up quite a bit. We are strong advocate of meds that work. Keeping as much native hair as you can it will allow a patient one of two things; either allow you to do less surgery or achieve a thicker result then you would be able to achieve with surgery alone. Either one is a tremendous benefit to the patient.
  21. Nice Work. Just stopped by my office for a brief moment to pick something up and had an opportunity to take a brief look at this post of Dr Feller's work. At a point in the industry, when on many occasions I feel possibly too many grafts may have been sacrificed in order to meet the necessary goals of the patient in regard to density. SMG and other fine clinics, have for many years meet the goals of many very particular patients with less hair, then what is being obtained today and posted on sites. In all the years, I have yet to see may post on how much respect and praise one has for the doctor and the plan that was designed around meeting the goals of the patient at the present moment along with preparing them for the entire journey and future as well. So I think this is a prefect example of an optimal procedure taking the entire art and science of transplantation into consideration. This patient has most likely been quite thin looking for a few years, compared to where he is, in a year he will look significantly better, a little more work is not going to change things much with a potential of increase risks. This patient will go from a thin bald look to a foundation that hides the scalp, if not most of the scalp and establishes a hairline that will frame in the face, provide a strong bench mark that will allow him to determine how much more he'll need, with out using anymore more hair then necessary to achieve it. Dr Feller established a hairline anterior but in line with the hair right be hide it, address the frontal half and anterior two third of the crown, which technically may help the bottom one third that is not addressed, in that the crown sits a bit on a slope. And, even if the donor is moderate in density, the patient should have one- third of his donor left to modify and thicken. Good example of well thought out work and doing what is appropriate looking at all the factors. The major ones: limited source, moving field and unknowns....never lose sight of these. I picked up what I needed to pick up and said what I had to say, and it is Saturday little after 1:30pm with clear skies and temps above Zero here in Minnesota??¦actually close to freezing 32F, need to find my daughter a new pair of Snow Board Boots??¦..Regards, Matt Zupan- Dr Shapiro Patient Educator
  22. Yes, this is not an accurate stat, primary because it was based on the American Society of plastic surgeons...very few plastic surgeons do Hair Transplants, in that specializing in Hair Transplants is so critical- most cosmetic surgeons are not going to give up all the other procedures they are trained to do and just do hair transplants. I remember in 1996 on the front page of Fortune magazine it read "He's so vein" pertaining to what men where spending on themselves in regard to cosmetic surgery Hair Transplants alone were 800 million and all the other cosmetic surgeries together, total of 14 different procedures were only 500 million. Transplants were almost double all the other procedures together. I am sure they are increase since then. So I would doubt male breast reduction would exceed transplants. Theoretically it makes sense that hair transplants would be so big. Hair is a big accessory to ones face and approx 75-85% of the male population has some degree of hair loss unlike big noses or man boobs and that universally the results of hair transplants are getting better.
  23. Smoking- no one really knows how long one needs to stop prior to surgery or when it is ok to start again after the procedure...and how much is too much, if one can not quit all together cut back dramatically around the surgery. After surgery is more of a concern, smoking cuts down the oxygenation in the blood and constricts blood vessel potentially influencing graft survival and proper healing. H-factor, was not to imply faulty genetic on behalf of the patient.... it is usually a weak link within the surgery, on behalf of the staff or outside factors already mentioned. If very thing is done right, generally everything should "grow".
  24. Hello not going to go bald, I will be happy to touch on these points...in retrospect. You absolutely need to think ahead about the " what ifs ". First off , the patients that show the great probability to go bald and become a type 6-7 are the ones that start showing signs of thinning early in their lives. The tendency is the younger one starts thinning, the faster their (the) progression and the more extensive their (the) hair loss. Even though an experienced physician can take various things into consideration to predict to some degree how it will progress, we ultimately don't know...they don't have a crystal ball to see the future. So, because we are dealing with a limited source and because the hairline that is created will be there forever , it is best to establish the hairline in a manner that is appropriate if the patient does progress to worst- case scenario. Unfortunately, the young patient wants a low, broad, thick hairline, (we understand this and there is nothing more we want to do then satisfy them, unless it could back them into a corner in 10-20years that is difficult to back out of), he wants what he had, he want what his peers have....this all make sense. However, these are ultimately the patients that one should not start aggressive on....in that they have the greatest potential to progress to more extensive hair loss. And, since we do not know (don't have a crystal ball) and because we are working with a limited source (don't lose sight of this), moving field (hopefully the products will stop it- but we don't know, we can hope) and the work needs to look natural now and down the road, it is best to establish the hairline in an appropriate area ... in following the patient, if in time there is indication he is going to" buck the system" and not progress and go bald (type6-7), we can step in and be more aggressive anteriorly and shift things down, broader, and stronger. We can always lower hairlines but we can not easily raise them. Hairlines always need to be in sync with the density and coverage behind them. If one establishes a lower, broader, strong hairline on a young patient that has all the potential to progress and go bald and this patient does not " buck the system " and can never establish enough density and coverage behind it, it will look quit peculiar. Generally the only males in nature that have these characteristics of their hairline are adolescent boys and men that maintain a full head of hair their entire lives. This we can not predict with young guys that are thinning. Technically young guys are generally the last patient you want to be anteriorly or posteriorly aggressive on , in that they have the greatest potential to progress to a type 6-7; they would not be thinning at this stage if they were not. I am not saying we need to be ultra ultra conservative, however, add these factors into your planning, establish a natural more then appropriate hairline, get on top of your problem and if in time something indicates you either don't have a genetic predisposition to progress or the meds are preventing this you can then get more aggressive. In regard to graft survival, there is no X- factor that affects survival; it is an H- factor. What this means is , if a doctor says everything was perfect and it was a text book procedure...sometimes with no explanation a percentage of grafts just do not grow and no one knows why. Many would say this it not correct...there is no X- factor. It is a n H- factor , a human factor . If something just does not grow it is that something went awry during the procedure, possibly in the dissection, mis handling of grafts, or the incubation of the grafts outside the body. Sometimes inside factors such as cigarette smoking, possibly extreme dense packing, multiple sessions, or scarred tissue can hinder growth , but not prevent it completely. Dr Shapiro has lectured extensively on yield, how to minimize waste and maximize survival. Hope this helps Matt Zuapn, Dr Shapior Patient Educator.
  25. Hello, My name is Matt Zupan and I represent the Shapiro Medical Group as Patient Coordinator/Educator. While I occasionally spend time reading the forum and following the progress of our patients, I often do not get the chance to respond to various threads. We have posted a few examples of some hairlines we have done. We have hundreds more. As you know we don't really try and push ourselves on the internet as our work and patients usually speak for themselves. But some of the comments on this thread made me want to explain our approach and give a few examples. http://www.hairrestorationnetwork.com/eve/showthread.php?t=144985
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