Dr. Paul Rose

I recently learned that Steve Gillen (Gillenator) posted a message about Pat Hennessey having a surgery with me. In that message he apparently included a statement that I trained Ron Shapiro.Dr Shapiro properly took offense at this statement and contacted me this morning. The statement is UNTRUE. I DID NOT train Ron and he DID NOT train me. Over the years Ron and I have tried to increase each other's knowledge and pass it on to other physicians via the ISHRS and Live Surgery Workshops. Steve Gillen also mentioned that Ron has been heavily influenced by my approach to hairline. I don't know where this statement arises from. I can say that both Ron and I have written and lectured about hairlines and that we have exchanged ideas on the subject. Lastly, I and at least another physician pay monies to Steve Gillen. I pay for him to monitor the web and keep me apprised of whats out there. Unfortunately I did not see the comments Steve made before posting them. I regret that any information may have been miscontrued.As Steve in essence works for me I take the responsibility for the error in the post and apologize to Dr Shapiro. Paul T Rose, MD

I have never worked for Bosley Paul T Rose, MD 813 259 9889 612 965 4247 paultrose@yahoo.com

There was a question raised about whether I had worked with Bosley. The answer is NO. Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com getfithairs.com

Dear Hairworthy; I found the thread. On my computer the word "here" is not really distinct in color . To answer your first question. I would agree the over the four day period the dose is probably adequate and would have similar effects to taking the Propecia in the same period. The half life of the drug suggests that taking it 4 or 5 times a week would produce suffcient levels to block DHT Your question about when to take the drug is interesting.I personally don't know the answer but I can make some calls to people involved in the research. Dr Rose 612 965 42427 813 259 9889 paultrose@yahoo.com getfithairs.com

Dear Hairworthy: I was unaware of your post and questions.Until recently I have not posted that often and have not regularly gone to the various websites with great frequency.I simply missed your post. If you can either direct me to your post or re-post the questions I will certainly try to reply to any of your questions. You are always welcome to write to me directly or call.I provide my personal and office numbers in my posts as well as my e mail. Paul T Rose. MD 612 965 4247 813 259 9889 paultrose@yahoo.com getfithairs.com

1. The natural inclination is to say that you are at a greater risk of losing more hair and more extensive loss but the fact is that geneticc hairloss is a bit unpredictable. Just yesterday I saw man in his late forties who inidcated that he had rapid hair loss form the tmeples and frontal area byt he time he was 18 or 19 but after a few years it stopped and he has a modest area of hair loss,more or less a type 3a. That siad I think it is reasonable to be on medications that can slow the process down. 2. You may still follow the patternof your father and half brothers but it is too soon to tell.we have learned that hairloss is multifactorial genetically, not just dependent on the maternal side. 3.I am pretty skeptical about Nioxin and have doubts about the L-Lysine as well. Interms of taking two of the propecia tabs the evidence showed that the response curve for Propecia is essentially equal ot that of the higher dose Proscar in terms of hair growth and halting hair loss. 4. Toppik, Dermatch and other camouflage agents can be very helpful 5.The jury is still out on Dutasteride. it is no doubt very effective in blocking both pathways to DHT. As you know the drug has not been approved for hair loss and the company does not seem to be pursuing FDA approval for such use. The hair loss market is rather large so it seems odd that they have elcted not to spend the money to oush for this if it is safe and effective. On the other hand some people have used it off label and report good reuslts. I have had patients who have obtained the drug and have not had such results 6. Severe dandruff (seborrheic dermatitis) can cause some hair loss and usually after treatmetn the hairs regrow. The condition msut be rather sever to cause such loss.treatmetns such as Nizoral, shampoos with ingredients such as tar, Seleniun sulfide and Salicylic Acid can be very helpful. Sometimes topical steroids can be helpful as well 7. hair loss can be devastating for young men and even older men. Sometimes seking medical/psychological advice can help. it is important to relaize that we can help the vast majority of patient with hair restoration but ultimately you must look toward yourself for confidence and recognize your worth to yourself and others 8. Putting traction on the hairs and pulling it out could ultimately cause hair loss. 9. 22 is a somewhat young age for a hair transplant butwith some of the methods we have there are times when conservative work can be done. Please feel free to contact me Paul T Rose, MD 813 259 9889 612 965 4247 paultrose@yahoo.com getfithairs.com

I appreciate the reply. No disrespect taken. I know you would be in great hands with Ron. I do feel that things posted as facts are somtimes incorrect.At times people miss the correct chronology of events amongst other things. I have perhaps been remiss in not promoting myself to a greater extent but I would at least like the historical record to reflect contributions I have made especially in the areas discussed. Thanks Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com getfithairs.com

I would like to clarify a few things. 1. Dr Shapiro does superb hairline work 2. In regard to hairlines I gave the first presentations and wrote the first article describing the aesthetic aspects of a natural the hairline after surveying many men and women who have retained their hair.The article was published in the International Journal of Cosmetic Surgery, Volume 6,Number 1, 1998 3.I believe that my work and that of the other physicians who work at Shapiro Medical have equivalent results and I particularly pride myself on my hairline design work and results.Smoothy is certainly entititled to his opinion but I do not know what basis he has for saying that my work is not on par with Ron's. Dr Shapiro did not train me. I have trained as a dermatologist and performed hair transplants before Dr Shapiro. I encouraged Ron to get into the field. We have known each other for over 20 years and have interacted as colleagues constantly exchanging ideas.I have learned various aspects of hair transplantation from many physicians and have hopefully helped them as well.Bill Rassman got Ron and I to start doing mega sessions and from there all three of us pushed each other.This work later developed into large session follicular unit grafting with the help of people like Bob Limmer, David seager, Bob Bernstein etc. Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com

I would like to clarify a few things. 1. Dr Shapiro does superb hairline work 2. In regard to hairlines I gave the first presentations and wrote the first article describing the aesthetic aspects of a natural the hairline after surveying many men and women who have retained their hair.The article was published in the International Journal of Cosmetic Surgery, Volume 6,Number 1, 1998 3.I believe that my work and that of the other physicians who work at Shapiro Medical have equivalent results and I particularly pride myself on my hairline design work and results.Smoothy is certainly entititled to his opinion but I do not know what basis he has for saying that my work is not on par with Ron's. Dr Shapiro did not train me. I have trained as a dermatologist and performed hair transplants before Dr Shapiro. I encouraged Ron to get into the field. We have known each other for over 20 years and have interacted as colleagues constantly exchanging ideas.I have learned various aspects of hair transplantation from many physicians and have hopefully helped them as well.Bill Rassman got Ron and I to start doing mega sessions and from there all three of us pushed each other.This work later developed into large session follicular unit grafting with the help of people like Bob Limmer, David seager, Bob Bernstein etc. Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com

Both Dr Shapiro and myself are using perpendicular incision (coronal) to varying extents.I am uncertain about the concept regarding the alignment of hairs in the adipose tissue since at the surface the hairs often exit in a clumped manner and then splay. I do think that providing a more acute angle does certainly provide an appearnce of more coverage. I am also trying to mix the incisions perpendicular and parallel in an effort to provide optimal coverage form any viewing angle. Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com getfithairs.com thehairlosscure.com

There are several problems inherent to prescribing Proscar for hair loss. One potential problem may occur because the drug is not necessarily dispersed evenly throughout the tablet and cutting the tablet may provide different doses. Another problem can arise if the medication is being paid for by insurance.Because Proscar is prescribed for prostate hypertrophy a male who takes the drug for hair loss may be labelled as having a prostate problem. If the patient changes insurance he may be told that he is not covered because of a pre-existing condition. In terms of expense some physicians have felt that Propecia can be taken 4-5 days per week and similar results could be expected because of the metabolism of the drug. Paul T Rose, MD 612 965 4247 813 259 9889 paultrose@yahoo.com

There are some interesting things happening regarding the bio engineering of hair. A company that I consult for named Intercytex has been able to take human dermal papilla cells (located at the hair bulb region), inject them into mice that are genetically engineered to prohibit rejection, and grow human hair on the mice. Human trials are underway. Dr George Cotsarellis at the University of Pennsylvania has been able to take stem cells and obtain human hairs from the cells.I believe that his work was published in the journal Nature. Various groups are working on gene therapy to try to find the genes that control baldness and then modify the genes to correct the problem.Theoretically one might be able to find the genes controlling various substances, alter the genes and place the altered genes in benign viruses or bacteria and then have affected persons acquire the viruses or bacteria by various means.Hopefully the genes would produce the correct inhibitory or promoting substance to either prevent or possibly treat the baldness. Paul T Rose, MD 813 259 9889 612 965 4247 paultrose@yahoo.com

We actually count the number of grafts being created and the recipient sites.Our technicians are given count sheets. The sheet is much like an Excel page. Each sliver is numbered and the number and types of grafts (1hair follicular units, 2 hair etc)are recorded for each sliver.The sheets are signed by each tech and the number are recorded. Throughout the case estimates are made to see where we are in trms of numbers of grafts. If it appears that we might be short the situation is discussed with the patient and he or she can decide whether we should try to obtain more tissue (if surgically reasonable), refund monies or add to another session if one is planned. In actuality we are generally over in terms of numbers of grafts and patients get more than what they paid for. Aditionally I keep a running count of the recipient sites, marking every 100 graft sites.We can compare my count with the the number of grafts cut by the techs. Paul T Rose, MD 813 259 9889 612 965 4247 paultrose@yahoo.com

Dear Arron: I would not worry at this point.Everything may be fine. It may be that you have had some shock loss and the area appears not to have changed. If this is the case the area should fill in over the next 4-6 months. At times growth may simply be delayed for unknown reasons. Again this may be a temporary delay and hair growth will resume. You will have to give it some time; at least several months before seeing your final result. I would agree with some of the suggestions to use finasteride and topical minoxidil (rogaine) Paul T Rose, MD paultrose@yahoo.com 612 965 4247 813 259 9889

Dear HT curious: here are some answers 1. FUE or FIT refers to a technique by which individual follicular untis are taken out from the donor area with a punch (a device that looks like a cookie cutter). FUE is an acronym for Follicular Unit Extraction coined by Rassman and Bernstein and FIT is an acronym for Follicular Unit Isolation named by Rose and Cole.Usually the punch device is 0.75 -0.1 mm in diameter. Strip harvesting refers to cutting out a strip of tissue often 1cm or slighly more in width and over 20 cm in length. The strip is cut down into smaller pieces and ultimately down to grafts. Those of us who use Follicular unit grafting utilize microscopes to develop the initial pieces termed slivers and then cut these down under the microscope to produce the individual follicular units. The strip harvesting technique produces a linear scar and must be sutured or stapled closed. With FUE we are generally limited to producing small numbers of grafts at a session; perhaps 400-700+ grafts. With strip harvesting it is not unusual to produce over 2500 grafts at a single session. FUE is an exceptionally tedious process 2. In terms of growth there does not appear to be any difference in the success of the grafts growing.Because the recipient area is generally approached the same way one would not expect a difference. Some mgiht contend that the grafts are palced sooner with FUE and might start to grow sooner but there are cases where growth has been delayed with both methods 3.Again one would not expect a difference inr esutls based on individual grafts growing. The difference may arise from the fact that more grafts can be done in session of strip harvested follicular unit grafts. Given equal numbers of grafts the results would be the same. 4.There would not be a differnece in terms of shock loss. In terms of scarring, FUE does not produce a linear scar. The wounds created with the small punches leave no evidence of scar except in rare cases. As a result patients who undergo FUE are more likely to be able to shave their heads and not reveal evidence of a procedure.That said there have been cases where patients who have undegone FUE have developed areas of hypopigmentation (light or white colored spots) where the grafts were taken from. This is more likely to occur in patients of Hispanic, Middle Eastern or Black African heritage.These people may also get increased pigmentation if the area. insuch cases patients would probably be unable to shave the head without revealing the procedure. Also as more and more grafts are extracted there can be a "moth eaten" appearnce to the donor area and in areas where the grafts are taken close together, a scar may be evident. 5.The difference in cost relates to the fact that the procedure is much more tedious. Paul T Rose, MD paultrose@yahoo.com 612 965 4247 813 259 9889

I would agree with Dr Charles. It is amazing and somewhat disconcerting to see men continue to bald even into old age. In fact soem men will lose hair from the nape of the neck and lose hair in an upward direction.

As was posted Proscar/Propecia tablets should not be handled by women of child bearing age as birth defects are theoretically possible if the drug is absorbed at particular times in fetal development. Studies on semen show that the amount of drug that would be absorbed is inconsequential.In fact quarts of semen would have to be used to show substantial amounts of the drug. That said, the safest thing to do is stop the drug. If anything were to go wrong with the birht of your child you might still wonder if the drug caused the problem

I generally suggest that you try medications before considering a hair transplant. I would recommend consulting with a hair transplant physician or dermatologist and inquire about Propecia and Rogaine. These medications can help to diminish hair loss and in some cases people experience significant regrowth. These medications work by different mechanisms and work synergistically. If after a year or so you feel that you are not improving or you believe that you want to pursue a more aggressive approach then a hair transpalnt might be the way to go. Once again I recommend that you consult with a reputable hair replacement surgeon. Hope this info helps Paul T Rose, MD

I would agree with Glenn Charles assessment.It would be very reasonable to go for two sessions of about 2000-2500 grafts using the strip harvesting method. The ability to go for ove 2000 grafts in each session would depend on scalp laxity and donor density. As one takes more tissue form the donor area the density decreases and the laxity may diminish as well. I would not try to obtain over 2000-2500 grafts because it would be very likely that the scar would be less than optimal.In removing the amount of tissue required there may be a great deal of tension on the wound, leading to poor scar formation.There can be people with incredible scalp laxity and very high donor densities but they are rare. Like Dr Charles I would create one scar if a person wants to use strip harvesting. If we were going to use the follicular isolation technique a linear scar would not be created. The down side of FIT would be the need to perform smaller sesions over 2-3 days to reach 2000 grafts. There are no adequate studies examining the rate of graft survival after multiple sessions. The theory that the first session is the best session is based on conjecture and anecdotal experience.

Let me start by stating that I do not think that using lasers for hair transplantation provides advantages and may have inherent disadvantages. I have worked with lasers since 1988 and believe that they can be very useful for other types of surgical procedures The original laser used in hair transplantation was the CO2 laser. This is a nonspecific laser that simply absorbs water. In the process it creates a great deal of thermal damage. The supposed advantage was that there would be little or no bleeding. Although the laser can limit bleeding, the heat generated would cause too much damage to surrounding hairs. Therefore it would not be sensible to use it in the donor area. Similarly it would not be reasonable to use it in an area of significant hair in the recipient area.Lastly the amount of bleeding in a hair transplant, performed the way we do it, bleeding is minimal. After the CO2 laser people tried the erbium laser with a sapphire tip. Like the CO2 laser this laser is nonspecific and absorbs water. It produces far less heat but still can cause a signifciant zone of thermal damage.There would remain the problem of working in between hairs in the donor area and because this laser does not coagulate bleeding to the extent of the CO2 laser there would be no advantage using it for harvesting. Again in the recipient area there would still be difficulty in making sites (though it would be to a lesser extent than CO2) in between existing hairs.A study performed by the doctor who promoted this laser found no advantage over the use of traditional methods. Add to all this the laser plume (the gases and material vaporized from the laser), the risk of eye damage, the bulkiness of the laser and problems with manipulation and you are left with little if any reason to consider the laser except as a marketing ploy. Of all the hair restoration surgeons that I communicate with I know of none that use a laser for hair restoration except when involved in studies for companies trying to engineer a laser that might work for the task. Also do not confuse these lasers with low level lasers that are non invasive. Some of these lasers are being touted to help hair loss. We are awaiting the studies to see if this pans out. Insofar as hair loss after the laser procedure. this may be simple shock loss in which case most of the hairs should grow back. It may also be that some hairs were damaged by the laser.

It's difficult to guarantee that you will not bald further on the sides. The balding process is continuous but it certainly can be controlled to a large extent with meds such as Propecia and Rogaine. Many factors play a role in trying to predict the extent of your baldness. One has to consider things such as your age, rate of balding, family history etc. It is important for the physician to plan for the worst case scenario.Careful planning for the future is crucial. If you are a type 5 going to a 6 one needs to evaluate the donor area( density, caliber of hair etc) very carefully.If it seems that you are going to have adequate donor then even if you began to develop a halo there may be enough donor to remedy the situation. In general the best approach is conservative; high hairline, limited surface area to cover and concentrate on the forntal one third to one half before tackling the crown prose@forhair.com www.forhair.com

There is very limited data on stress and hairloss. As you can imagine it is very difficult to quantify stress. We do know that stress causes release of various hormones and other chemicals. Some of these substances seem to limit immune function, other seem to have effects on the cardiovascular system and gastrointestinal tract. There are some studies correlating stress and cardiac risk. There are reports of stress causing hair loss and greying of hair but the primary cause of both of these seem to be genetics. There are various conditions including malnutrition, anemia and thyroid disease as well as other diseases that can cause hair loss. These entities often cause diffuse hair loss.

Great questions It seems that most hairs that are susceptible to the effects of male pattern baldness go through a process of miniaturization where the caliber of hair diminishes with successive cycles. There are apparently some situations as VOCOR pointed out in which hairs may simply be lost before miniaturizing.This is an interesting area of research and probably involves something termed apoptosis (programmed cell death). It is a subject that I am currently involved in studying. It is possible to retain follicular unit density and hair density in areas while balding but the decrease in caliber of the hairs that occurs has a dramatic effect on the appearance of overall density.That is to say that as the hairs get smaller the ability to cover the scalp becomes increasingly difficult. Whether we can cover an area with hair transplants thinly or densely depends on multiple factors. Some of these are the surface area to be covered, the donor hair available, the caliber of the donor hairs, the texture of the donor hairs, the color as well as other things. For instance a patient with a Norwood type 3 who is 45 years old, has good donor density, blond hair and curly hair can get a result that demonstrates high density and superb coverage.It all boils down to mathematics. We rob Peter to pay Paul. It is important to recognize that when you are born you probably have 80-100 follicular units per sq cm. When one notices a significant degree of hair loss he is probably at a density of less than 40 follicular units per square cm. In most instances we can get very reliable results at densities of 20-30 follicualr units in a session of transplants. If someone is totally bald this would provide a thin look and the person would often return for a second session. If the pre-op existing density is greater than perhaps 10 follicular units per sq cm the results may be more than adequate. Again alot depends on the quality of hair being transplanted Hope this is useful

I do not know the laws in Virginia but I believe that in most cases such action would be illegal.To have a nonlicensed person performing surgery would probably constitute practicing medicine without a license. I believe that such action is reportable to the state board of medicine

I do not know the laws in Virginia but I believe that in most cases such action would be illegal.To have a nonlicensed person performing surgery would probably constitute practicing medicine without a license. Ib eliev