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  1. Mosaic® Hair Restoration is a new approach to hair transplant that has been developed exclusively by Drs. Bernard Nusbaum and Paul Rose at the Hair Transplant Institute of Miami. This article provides in-depth information on the procedure. Transplant 101: From Exam to Restoration Surgical hair restoration is truly fascinating. Conceptually, the procedure has one goal: To extract hair from one area of the scalp, and relocate (transplant) it to other areas affected by thinning, shedding, or balding. With that in mind, hair transplant procedures can be analyzed according to 4 critical phases. They include: 1. Examining the donor area: This is a major part of determining patient candidacy. In this phase, the surgeon will examine the area from which donor hair will be extracted to ensure enough healthy, viable grafts can be obtained to complete the procedure. 2. Extracting donor hair: This phase occurs during the actual procedure. Donor hair can be extracted through manual “strip” harvesting or follicular unit extraction (FUE). The latter is achieved through the use of a special punch instrument that measures just a couple millimeters in diameter, which is used to “scoop” minute clusters of hair follicles. 3. Separating donor grafts: Following extraction, donor grafts are separated and prepped for transplant. In this phase, it is vital that each graft is preserved and remains viable for transplant. 4. Restoring the recipient area: Perhaps the most important phase, restoration of the recipient area is achieved by surgically implanting each graft along the patient’s hairline, crown, or other areas affected by hair loss. Why Mosaic®? Surgeons are often selected based on their track record for creating a natural end result. It is not uncommon for patients to scour the Web, pouring over endless product endorsements, patient testimonials, and galleries of before and after photographs. Most are looking for the same thing: Assurance that their hair will not just be restored, but also returned to the state it was before hair loss began. Mosaic® Hair Restoration has been developed to meet that need. Commenting on the procedure, Dr. Bernard Nusbaum explains: We have observed that follicular units naturally occur in an arrangement consisting of unique percentages of one, two, and three hair follicular units in different mixed configurations with unique inter-follicular distances –in other words: a unique pattern for each individual. Our novel procedure consists of designing the recipient area in this individualized manner, different for each patient, mimicking their unique follicular unit arrangement pattern and have termed this the Mosaic® Hair Restoration. Visit the following link to learn more about hair transplant in Miami.
  2. Dr. Bernard Nusbaum is well-known in the city of Miami as an elite hair restoration surgeon. His expertise has been recognized worldwide as well, after being awarded the 2015 Golden Follicle by the International Society of Hair Restoration Surgery (ISHRS). Dr. Nusbaum has well over 10,000 hair surgeries under his belt, making him one of the most proficient and experienced transplant specialists in the world. In this video, Dr. Nusbaum explains the difference between two of the most common types of hair transplant surgery: The “strip” procedure, and newer follicular unit extraction (FUE) procedures. Below, readers are invited to learn more about each of these highly refined and effective approaches to hair loss treatment. Following the text, readers will find a video interview with Dr. Nusbaum, in which each procedure is explored with great detail. Strip Donor Hair Transplant The “strip” procedure is perhaps the most known out of all surgical hair restoration procedures. It gets its name from the strip of scalp that must be removed in order to harvest donor hair for the transplant. Removal of this strip also leaves the patient with a linear scar that might be seen when hair is buzzed short (e.g. with a #2 razor). For many patients, this is a deal breaker. However, as Dr. Nusbaum explains, not all donor scars are created equally. Patients who would like to take advantage of the strip donor procedure will be happy to know that there are ways to minimize the appearance of the linear scar that strip procedures notoriously leave behind. Of course, great care must be taken to select a surgeon who has the technique, expertise, and satisfied patients to validate his or her abilities. At the Hair Transplant Institute of Miami, Dr. Paul Rose provides an approach known as the trichophytic ledge closure to mask the signs of the donor area scar by artfully directing individual hairs to grow around and through it. After the linear strip is removed, surgeons carefully dissect it into groupings of 1-3 follicular units. These units are then implanted into the patient’s recipient area—that is, the area experiencing thinning, excessive shedding, or balding. Follicular Unit Extraction (FUE) A newer approach to hair restoration surgery is achieved through the use of follicular unit extraction (FUE). Surgeons who employ this technique use a small punch instrument, usually measuring just a millimeter or two across, to individually harvest clusters of follicular units. In this way, surgeons bypass the need to extract a linear strip of scalp. Thus, there is never a linear scar, even when the patient’s hair is cut short (e.g. shaved, or buzzed with a #2 razor). However, the punch instrument is known to leave light reddish dots at the site of each extraction. These dots might be visible when the hair is cut short, depending on how short the patient cuts it and how he or she styles it. Once extracted, the hair restoration process proceeds in a similar fashion as the strip donor procedure described above. The surgeon takes each donor unit and implants it within the recipient area. This might include the hairline, the sides of the scalp, or along the rear crown of the head where pattern baldness is usually most obvious. Watch the Video Interview on YouTube Visit the following link to . A Note on Restoration In both strip donor and FUE procedures, it is noteworthy to mention that the surgeon manually places donor hair to achieve a desired look and feel in the recipient area. This is a vital part of the procedure, and many experts believe placement of donor hair is what separates an average hair transplant from an extraordinary one. Like an artist, the surgeon must carefully use his expertise and materials (donor hair) to create the appearance of a natural head of hair. Undulation is among the most important characteristics to consider, specifically when restoring the frontal hairline. Donor hair must be inserted in a fashion that naturally flows inward and outward along the natural curve of the hairline. Another important factor to consider is “irregular irregularity,” which means that natural hairlines often have hairs dispersed randomly in front and behind the hairline. Without preserving irregular irregularity, hair transplants may look painfully obvious, resembling a straight line across the forehead that is anything but natural. Readers are invited to visit Miamihair.com to learn more about Dr. Bernard Nusbaum, and Dr. Paul Rose. <!--EndFragment-->
  3. Dr. Bernard Nusbaum is well-known in the city of Miami as an elite hair restoration surgeon. His expertise has been recognized worldwide as well, after being awarded the 2015 Golden Follicle by the International Society of Hair Restoration Surgery (ISHRS). Dr. Nusbaum has well over 10,000 hair surgeries under his belt, making him one of the most proficient and experienced transplant specialists in the world. In this video, Dr. Nusbaum explains the difference between two of the most common types of hair transplant surgery: The “strip” procedure, and newer follicular unit extraction (FUE) procedures. Below, readers are invited to learn more about each of these highly refined and effective approaches to hair loss treatment. Following the text, readers will find a video interview with Dr. Nusbaum, in which each procedure is explored with great detail. Strip Donor Hair Transplant The “strip” procedure is perhaps the most known out of all surgical hair restoration procedures. It gets its name from the strip of scalp that must be removed in order to harvest donor hair for the transplant. Removal of this strip also leaves the patient with a linear scar that might be seen when hair is buzzed short (e.g. with a #2 razor). For many patients, this is a deal breaker. However, as Dr. Nusbaum explains, not all donor scars are created equally. Patients who would like to take advantage of the strip donor procedure will be happy to know that there are ways to minimize the appearance of the linear scar that strip procedures notoriously leave behind. Of course, great care must be taken to select a surgeon who has the technique, expertise, and satisfied patients to validate his or her abilities. At the Hair Transplant Institute of Miami, Dr. Paul Rose provides an approach known as the trichophytic ledge closure to mask the signs of the donor area scar by artfully directing individual hairs to grow around and through it. After the linear strip is removed, surgeons carefully dissect it into groupings of 1-3 follicular units. These units are then implanted into the patient’s recipient area—that is, the area experiencing thinning, excessive shedding, or balding. Follicular Unit Extraction (FUE) A newer approach to hair restoration surgery is achieved through the use of follicular unit extraction (FUE). Surgeons who employ this technique use a small punch instrument, usually measuring just a millimeter or two across, to individually harvest clusters of follicular units. In this way, surgeons bypass the need to extract a linear strip of scalp. Thus, there is never a linear scar, even when the patient’s hair is cut short (e.g. shaved, or buzzed with a #2 razor). However, the punch instrument is known to leave light reddish dots at the site of each extraction. These dots might be visible when the hair is cut short, depending on how short the patient cuts it and how he or she styles it. Once extracted, the hair restoration process proceeds in a similar fashion as the strip donor procedure described above. The surgeon takes each donor unit and implants it within the recipient area. This might include the hairline, the sides of the scalp, or along the rear crown of the head where pattern baldness is usually most obvious. Watch the Video Interview on YouTube Visit the following link to . A Note on Restoration In both strip donor and FUE procedures, it is noteworthy to mention that the surgeon manually places donor hair to achieve a desired look and feel in the recipient area. This is a vital part of the procedure, and many experts believe placement of donor hair is what separates an average hair transplant from an extraordinary one. Like an artist, the surgeon must carefully use his expertise and materials (donor hair) to create the appearance of a natural head of hair. Undulation is among the most important characteristics to consider, specifically when restoring the frontal hairline. Donor hair must be inserted in a fashion that naturally flows inward and outward along the natural curve of the hairline. Another important factor to consider is “irregular irregularity,” which means that natural hairlines often have hairs dispersed randomly in front and behind the hairline. Without preserving irregular irregularity, hair transplants may look painfully obvious, resembling a straight line across the forehead that is anything but natural. Readers are invited to visit Miamihair.com to learn more about Dr. Bernard Nusbaum, and Dr. Paul Rose. <!--EndFragment-->
  4. Like a lot of guys, I wanted to do something about my hair loss. Before I found this forum I had no idea where to go. I was more concerned with getting a quality procedure more than cost. My first consultation was with Bosley in Boca Raton, and my first instinct was that it was similar to buying a used car (down to the shifty salesman with less than stellar transplants himself). At Bosley they made it seem like it was a real treat for me to actually get seen by a doctor ??“ whereas usually that would only happen after I had committed to the surgery there. My next step was to get a consultation with a rep from MHR. Not only was there no doctor at that consultation to check my scalp and give me an idea for what I could expect, but the sales guy gave me expectations that even a novice like me knew were too flowery to be believable. Ironically, it was the salesman from MHR who pointed out that I should look on-line for critiques and reviews of MHR and other transplant doctors. When I came to this forum I found a ton of information that both eased my trepidation with the procedure as a whole and insightful warnings about going to "hair mills" that matched my gut feeling having been to the 2 different consultations. After reading over the hair transplant doctors in Florida I scheduled consultations with Dr. Bernard Nusbaum of the Hair Transplant Institute of Miami, Dr. Charles of the Charles Medical Group, and Dr. Jeffrey Epstein of the Foundation for Hair Restoration. What struck me initially was the fact that I was able to schedule appointments with all 3 within days of the call whereas Bosley and MHR required me to wait almost a month for a consultation. I must say that I was shocked at the degree of professionalism and candor that all three doctors showed in their respective consultations. I went from feeling like I was shopping for a used car (at the hair mills) to consulting a professional helping me make a potentially life-altering decision. It also struck me that neither Bosley nor MHR offered me a prescription for Propecia. All three of doctors I consulted with from this forum offered it and I promptly began using it. All three doctors gave remarkably similar presentations with realistic expectations. And without going into specifics (primarily because I don't remember them), all three doctors were markedly less expensive than either hair mill I visited (my guess is because they don't have the outrageous advertising budgets and salesmen commissions to cover). I have nothing particularly bad to say about Dr. Charles and Dr. Nusbaum. I chose to have Dr. Epstein do my procedure primarily because of the attention to care that I received from him and everyone in his office. The procedure was done May 7, 2008. I appreciated the fact that Dr. Epstein quoted me a flat fee instead of a per follicle cost (which might have left me wondering throughout the entire procedure how much this was going to cost). Truthfully it was initially a toss-up between Dr. Epstein and Dr. Charles, but Dr. Epstein's projected follicle transplant number was significantly higher and I personally preferred his results photos found on this forum. I don't remember what the exact breakdown was of the 1s, 2s, etc but my total was approximately 2,876 (which was higher than his initial estimate). Not that it was a deciding factor for me, but as soon as I first entered his office I noticed that every single person in Dr. Epstein's office was extremely personable. There aren't enough good things I can say about my experience with Dr. Epstein. The whole procedure went more smoothly than I could have imagined. I would urge anyone considering a hair transplant to consult several clinics/doctors, and I would personally recommend Dr. Epstein.
  5. I selected Dr. Nusbaum after seeing his video on the web. I already had 2 consults with the larger chain operations, but something just didn't feel right. I met with Dr. N. for a consult, and I felt comfortable with the decision to move forward with the procedure. Procedure date: May 22,2007. Total follicular units: 2693. 646-1's 1212-2's 835-3's and 4's Dr. Nusbaum and his staff were wonderful. It was a very positive experience. My hair started growing after the 3rd month. It has now been approximately 6 1/2 months. I just had a follow-up appointment, wherein Dr. N. told me I could expect another 20-30% growth. I would certainly recommend Dr. Nusbaum.
  6. Dr. Bernard Nusbaum discusses his medical background and why he began performing today's state of the art hair transplant procedures.
  7. Dr. Bernard Nusbaum discusses what separates his hair restoration clinic from others and why patients should choose him for their surgical hair restoration needs.
  8. Dr. Bernard Nusbaum discusses the services and procedures he offers hair loss sufferers visiting his hair restoration clinic. This includes help with research, medical hair loss treatments and hair transplants.
  9. Dr. Bernard Nusbaum discusses what hair loss sufferers considering hair transplant surgery should look for in a quality hair restoration physician. This includes qualifications, experience, looking at patient hair transplant photos, meeting patients and getting a first-hand look.
  10. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernard Nusbaum discusses the importance of educating hair loss sufferers and helping them meet their hair restoration needs.
  11. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernard Nusbaum discusses why he takes time helping his patients understand the hair transplant procedure.
  12. Losingslowly I think you are proceeding correctly by doing your due dilegence. I am sure Dr. Bernard Nusbaum would be glad to see you for consultation. He is also located in Coral Gables and does excellent work. He is one of only a few docs I would let do a hair transplant on me if I were to ever need it. If you want to travel 45 minutes north to Boca Raton I would also offer you a complimentary consultation. More opinions are good. You do not have to make any quick decisions. Wait til you are good and ready.
  13. Last year in March I decided I wanted to find out about getting a hair transplant. My mother had mentioned that she had seen a TV show about hair transplants, and took down the web site address for Dr Nusbaum. Since I live in South America I did all the research on the Internet. I sent pictures of myself by e-mail and gave me an appointment for June last year (2004). Since I had a lot of hair loss area I immeditely asked how long I had to wait for a second transplant. I got my second transplant in March this year (2005). I had a great experience. Everything went according to plan, and happened exactly as it was explained to me. I had hardly any pain during the transplant or afterwards. The only thing that was a little unpleasant was a little itching especially in the donor area, which lasted a couple months.
  14. Recently, the Publishers of the Hair Transplant Network attended the 2010 18th annual ISHRS scientific meeting held in Boston from October 20 th through the 24th. Each year hair restoration physician from around the world gather for several days to attend lectures, meetings, workshops and discussions focused on hair loss treatments. It’s practically impossible to cover all of the important topics discussed at the meeting. Thus, this report will feature the highlights that may be of most interest to hair loss sufferers and those wanting to restore their hair. A few of these topics have been discussed and debated by patients for years online using our hair loss forum, while other topics provide information on innovative techniques and treatments that may potentially revolutionize the hair restoration profession in the future. However, despite some exciting anecdotal evidence provided in various presentations, it’s important to remain cautiously optimistic while much needed research continues and investigation is underway. Some of these topics include the benefits, limitations, and refinements in follicular unit extraction (FUE), its tools and techniques (including the controversial NeoGraft hair transplant machine); treating and minimizing the risks of scar stretching via follicular unit hair transplantation (FUT); Platelet Rich Plasma as a storage solution for grafts; Bioengineering of the hair follicle (hair multiplication) including exciting preliminary findings using the highly talked about formula ACell; the advantages and disadvantages of dense packing; studies on the causes and treatments for female hair loss and more. The attention to detail at these meetings is highly impressive and hair transplant surgeons who regularly attend deserve to be commended for their dedication to continuing education. Background on the ISHRS, Meetings and the New President The primary mission of the ISHRS (International Society of Hair Restoration Surgery) is to educate hair restoration physicians ranging from the beginner to the master. It is by far the most prominent hair restoration professional organization in the world and the host of the five day annual scientific meeting. Their website (www.ISHRS.org) provides useful information about hair restoration and profiles and contact information for its 700 worldwide physician members. Many of the physicians well recognized by patients online for achieving excellent results have also become well known and respected by their colleagues as leaders and teachers in the industry. Many leading physicians recommended by this community led or were a part of almost every discussion panel. At the meeting, highly esteemed Coalition member Dr. Jerry Cooley of Charlotte, NC became the acting President of the ISHRS for the coming year. Physician Recognition and Awards: The “Golden” and “Platinum” Follicles The “Golden” and “Platinum” follicle awards are the highest honors given to leading surgeons in hair restoration by the ISHRS at each meeting. These awards recognize outstanding achievement in basic scientific or clinically-related research in hair pathophysiology or anatomy as it relates to hair restoration. Congratulations to recommended physician Dr. Damkerng Pathomvanich of Thailand, Asia who received the Golden Follicle and Coalition member Dr. Bill Reed who was awarded the Platinum Follicle. To learn more about these prestigious awards and to congratulate these highly esteemed physicians, visit the discussion forum topic “2010 ISHRS Physician Awards: The Golden and Platinum Follicles”. See the formal Press Release. Congratulations as well to Dr. Dow Stough for winning the coveted Manfred Lucas Award for his many contributions to the advancement of physician and staff education, including his long time role in founding and nurturing the International Society of Hair Restoration Surgery (ISHRS). The critical role played by hair restoration technicians in preparing and placing grafts, was also recognized with a “Distinguished Assistant Award”, which this year was awarded to Emina Karamanovski. She is the hair transplant coordinator at the Lam Institute for Hair Restoration in Dalllas and has trained physicians and their staffs through out the US and Canada. She has also lectured widely on maintaining quality control and co authored the second volume of the book Hair Transplant 360 with Samuel M. Lam M.D., F.A.C.S. This second volume is written specifically for training medical assistants and includes numerous educational videos on DVD. Presentations at the ISHRS meeting of particular interest to Hair Loss Sufferers The Advantages, Limitations and Refinements in FUE, its tools and Techniques Given the increased number of inquiries about FUE on our forum over the last year, no wonder FUE has become a hot topic of discussion and debate amongst hundreds of hair transplant surgeons. Many leading surgeons consider follicular unit extraction (FUE) a viable alternative to follicular unit hair transplantation (FUT). Others feel that FUE may eventually replace FUT and yet others reject its use entirely and feel that its lack of consistency in results is enough to prevent them from incorporating this technique into their practice. However, due to the increased patient interest and refinements in various tools and techniques, several surgeons initially turned off by FUE are starting to recognize its place in the hair restoration profession. Below, we feature several innovative tools surgeons are using to perform FUE procedures. But just because someone is handed a hammer, doesn’t mean that everyone knows how to use it properly and efficiently. The vast majority of leading surgeons agree that the experience and skill of the surgeon performing the procedure is always paramount over any tool they use. Inexperienced hands with any tool are extremely dangerous to patients and the outcome of the procedure. It’s also doubtful that any tool listed below or otherwise will become universally accepted amongst hair restoration physicians. However, these tools do provide options for surgeons performing FUE. Just as there’s always more than one way to skin a cat, there’s always more than one tool available for experienced surgeons to choose from to perform an optimal FUE procedure. The SAFE System – Powered Scribe by Dr. Jim Harris Dr. James Harris presented the “Powered SAFE Scribe“, a new and revolutionary surgical FUE tool at this year’s 2010 ISHRS meeting. Research and testing have proven that this new powered instrument is even more effective than its manual, non-powered predecessor. The Powered SAFE Scribe is safe and effective in the hands of a skilled hair restoration physician and can reduce the time it takes to perform the procedure by half. Extraction rates of 500-700 per hour have been reported using the new powered version of the Scribe as opposed to approximately 200-300 with the manual one. Benefits include a reduction in pain, minimal scarring, more patients can become candidates based on donor characteristics, minimal transection and decreased time. Additionally, because this tool uses “blunt dissection” as opposed to a sharp punch, angle and direction of the punch is less critical to avoid transection of the hair follicle. The cost of Dr. Harris’ Powered SAFE scribe is approximately $3200. Dr. Jean Devroye’s Proprietary Motorized FUE Tool In an attempt to improve the quality of results patients can achieve with FUE, Coalition member Dr. Jean Devroye designed and has been using a unique powered instrument for FUE hair replacement procedures. This device was designed to improve the speed of the follicular unit extraction procedure while maintaining the same effectiveness as when performed manually by a skilled surgeon. This new powered FUE device works by spinning alternatively with a low angular motion. This allows for fast and effective penetration of the scalp and extraction of the follicle while keeping the risks of damage to the follicles virtually nonexistent. Its speed is controlled by a foot treadle allowing for better hand control of the device. While Dr. Devroye believes his FUE tool prototype helps to increase the speed of the hair restoration procedure, he admits it doesn’t reduce the already very low transection rates he achieves while performing follicular unit extraction with a manual tool. Dr. Devroye’s powered FUE instrument has allowed him to increase the number of follicular unit grafts he can transplant daily via FUE from approximately 1200 to 1500 per day. Above all else, Dr. Devroye feels the skill and experience of the physician and the size of the punch are crucial in achieving optimal results. By his observation, Dr. Devroye determined that smaller punches can easily increase the transection rate of hair follicles during the extraction process. For this reason, Dr. Devroye prefers using slightly larger 1 mm punches instead of incredibly tiny punches as small as 0.7 mm. In his experience, scars obtained with a 1 mm punch are hardly noticeable, even with a short hair cut. The cost of Dr. Devroye’s FUE tool is approximately $3000. Dr. Robert True Motorized FUE Coalition member Dr. Robert True has over 7 years experience with FUE and feels that he gets the best results with a rotary hand engine FUE tool with a sharp punch system and variable speed control. This unit can be purchased for approximately $1500 and the punches can be replaced as needed for less than $50 a piece. Dr. True believes that the skill and experience of the surgeon is critical to achieving optimal results in addition to working with only those patients who make good candidates for FUE. Dr. True can extract between 400 to 600 follicular units (FUs) per hour from the scalp with approximately 2 to 5% transection, 300 to 400 FUs per hour from the beard with 2 to 4% transection and 150 to 350 FUs per hour from the torso with approximately 8.7% transection. Each follicular unit is then inspected under microscopes, a practice not typically performed by most FUE clinics. Dr. True feels this is essential in maximizing optimal hair growth yield. The NeoGraft Machine No other FUE tool has stirred up as much controversy amongst patients and physicians as the much hyped NeoGraft machine. To learn more about how the NeoGraft works, including several concerns about the functionality and promotion of this device, visit “Can the NeoGraft Machine Revolutionize FUE?” Dr. Bob Bernstein also provides an excellent review of this tool on his website at “NeoGraft Hair Transplant Machine for Follicular Unit Extraction". In his review, Dr. Bernstein points out that the suction function of the Neograft machine introduces two risks not present with other FUE techniques: The suction has a tendency to strip the surrounding tissue from the lower portion of the grafts during their removal, exposing them to drying injury. The vacuum creates a continuous flow of dry air around the harvested grafts Physicians at the meeting also expressed their concern that the NeoGraft machine was being marketed aggressively to physicians with no training or experience with hair transplant surgery. However, despite the controversy the NeoGraft does have some useful features that have been reported advantageous by surgeons using this device such as Dr. Leonard who presented information on it at the ISHRS conference. Reported advantages include extractions quicker and easier to perform than manual tools and less manipulation of the follicles (uses suction rather than forceps). Disadvantages of this semi-automated NeoGraft device include the high cost of the machine ($80,000), potential desiccation (dehydration) of the follicles from the pneumatic pressure, and the potential damage to the follicles during the suction process. Dr. Leonard feels confident that the NeoGraft machine extracts healthy follicles with minimal transection but admits that FUE as a whole is only for a small group of qualified candidates. Summary The above presentations focused primarily on extracting follicles from the donor area. However, placing these fragile follicular units into tiny recipient incisions is just as critical to ensure optimal growth. FUE is still relatively new and most leading surgeons agree that while FUE has a place in hair restoration, despite its increasing popularity, not everyone is an optimal candidate. Thus, it’s recommended that patients explore and discuss the benefits and limitations of both FUT and FUE with several leading hair restoration physicians they’re considering for surgery. Minimizing and Treating Stretched Donor Scars from Follicular Unit Hair Transplant Surgery (FUT) Minimizing the appearance of the donor scar is a high priority for most hair transplant patients and leading hair restoration physicians alike. That’s why creating an optimal donor scar is a hot topic, not only on our forum, but also amongst leading physicians at the ISHRS scientific meeting this year. The number one cause of a stretched donor scar is closure under high tension and/or poor surgical planning and suturing. And while the majority of leading physicians produce minimal scarring in the majority of patients closing the wound under minimal tension with the newest trichophytic closure technique, stretched scarring can also occur for unknown reasons due to a patient’s physiology, although this is reported as rare. So what can be done to reduce the appearance of a scar once it’s already stretched? Patients with wide donor scars can sometimes undergo another strip procedure to attempt to reduce scarring. The old scar is harvested with a new strip and the new wound is closed under minimal tension using today’s state of the art techniques including the “gold standard” trichophytic closure. Double layer sutures are often used in order to reduce tension on the wound and minimize the air pockets underneath the scar. While at least some improvement is typical, optimal scarring isn’t always possible depending on the severity of the first scar. Dr. James Harris presented the value of filling the scar with FUE grafts to minimize the appearance of the scar. He believes this method is valuable for patients who are fearful of another strip harvest, lacks scalp elasticity or already had previous scar revisions via harvesting another strip with no or minimal success. Dr. Harris feels that a density of 20 to 25 FU/cm2 placed into the scar is sufficient to camouflage the scar. Coalition member Dr. James Vogel discussed the use of an expander for extreme cases in which the old scar is removed and an expander is inserted for a short time in order to expand viable and healthy tissue. Once removed, extra healthy skin is available while scarred tissue is significantly reduced. While keloid and hypertrophic scars (tissue abnormalities that can develop during the healing process) are very rare with today’s refined donor harvesting and closing techniques, Coalition member Dr. Sharon Keene presented evidence to suggest that Ace Inhibitors such as enalapril may effectively improve their appearance. Additionally, the likelihood of any reoccurrence was reported as minimal. Surgeons agree that the best remedy for stretched scarring is to prevent them from occurring. Thus, by carefully screening candidates and closing donors under minimal tension using a trichophytic closure is considered today’s “Gold Standard”. Platelet Rich Plasma as a Graft Storage Solution Whether or not Platelet Rich Plasma (PRP) is effective in treating hair loss has been a hot topic on our forum. And while there was no discussion of this at this year’s annual meeting, Dr. Melike Kulahci, who is recommended on the Hair Transplant Network presented studies regarding the use of PRP as a storage solution for dissected follicular unit grafts while outside of the body. The aim of the study was to determine the effects of PRP on wound healing and transplanted hair growth yield. After conducting a study on 300 patients, it was determined that postoperative crust/scabs fell off more rapidly however, shock loss still occurred. More research is needed to determine whether or not growth yield is higher using PRP as a graft holding solution. Preliminary Findings Cloning Hair Shafts with ACell MatriStem MicroMatrix There’s nothing that promotes as much excitement in balding men and women as the concept of being able to clone thousands of precious hair follicles until all of the balding areas are fully covered and hair loss is no longer a problem. While the majority of research on hair multiplication (cloning) to date has been in cloning derma papilla cells in order to reproduce a healthy, growing follicle, Coalition member Dr. Jerry Cooley has reported some exciting (although preliminary) findings in potentially creating derma papilla from hair shafts using the ACell MatriStem MicroMatrix. ACell Matrix MicroMatrix has been FDA approved for wound healing and has demonstrated benefits in healing injuries adjunct to surgery. Dr. Cooley has been using this product which is available both as a powder and a sheet for the last 18 months to study its effects on strip harvesting donor wound healing, FUE and punch harvest sites, dissected follicular unit grafts via FUT and last but not least, its use with the hair duplication (formerly known as “autocloning”) technique in which plucked hairs are used for grafting. Dr. Cooley feels that the ACell Matrix MicroMatrix solution demonstrated overall improved scarring. Most exciting however is Dr. Cooley’s report on hair duplication (autocloning). Dr. Cooley reported that by dipping plucked hairs in the ACell Matrix MicroMatrix solution and transplanting them into tiny prepared recipient sites - approximately 30 to 50% of these hairs actually began to grow. Since the donor area still contained the follicle, it would reproduce new hair. Meanwhile, evidence suggests that some of these transplanted hair shafts may indeed be reproducing follicles and derma papilla in order to continue growing. While the above preliminary findings are exciting, Dr. Cooley admits that the permanency of these “plucked” growing hairs are unknown and more research is needed before drawing any kind of real conclusions. Causes and Treatments for Female Hair Loss While male pattern baldness (androgenic alopecia) is pretty well understood by doctors as a condition by which the hormone DHT plays a major role in attacking healthy follicles genetically susceptible to it, whether or not DHT plays a role in female hair loss isn’t entirely understood. Thus, many hair restoration physicians are still asking, does androgenic alopecia truly exist in women or is it something entirely different? Dr. Andrea Marliani of Italy believes that insufficient local follicular estrone activity rather than increased levels of DHT may be responsible for the majority of hair loss cases in women. If this is the case, true androgenic alopecia doesn’t exist in women and should be renamed to something more suitable such as Low Local Estrone Alopecia or Estrone Deficiency Alopecia. Moreover, the above would mean that any antiandrogen treatments such as finasteride (Propecia) (which is prescribed by doctors to some women beyond child bearing years and/or not interested in having children) would be entirely ineffective in treating women with hair loss. To make matters more confusing, contradicting studies were presented at this year’s conference on the effectiveness of finasteride in the treatment of female related hair loss. Despite a smaller recent study suggesting that finasteride has no effect in women, Coalition member Dr. Sharon Keene reported findings demonstrating the positive effect of finasteride in some women with hair loss. This suggests that femaleresponders to finasteride have androgen mediated hair loss. Additionally, a large percentage of women who suffer from Polycystic Ovarian Syndrome (PCOS) also experience hair loss. Women with PCOS experience high levels of androgens (male hormones like DHT) in the body and as a result, are more susceptible and likely to experience hair loss. The above data suggests therefore, that at least some level of androgenic alopecia exists in women. Whether or not it’s as common in women as it was originally thought requires more research. It should be noted that each female should undergo a full medical examination in order to determine the specific cause of her hair loss. Determining the cause in each case is crucial in treating it. Advantages and Disadvantages of Dense Packing Whether or not to dense pack grafts and how closely they should be transplanted next to one another has been a hot topic amongst patient and physicians alike for years. Large densely packed hair transplant mega and giga sessions are desirable to patients since it often minimizes the number of subsequent procedures needed. But how many grafts/hairs can be transplanted safely in a square centimeter before growth yield is affected? Who is and who isn’t a candidate for dense packing? Coalition members Dr. Arthur Tykocinski of Brazil and Dr. Jerry Wong of Vancouver feel that dense packing up to 40 to 50 FU/cm2 when appropriate for the patient can produce optimal yield. However, these larger numbers are typically only achieved with single haired FUs. Not as many double, triple or quadruple haired follicular units are needed per square centimeter in order to provide the same appearance of density. Other physicians feel that a slightly more conservative approach to preserve the scalp’s blood supply is a better option. While a difference of opinion and philosophy will most likely always exist surrounding dense packing, how much and when to do it, the majority of leading hair restoration surgeons do agree that just because you can, doesn’t mean you always should. Due to the limited donor hair supply, dense packing too many grafts in a small area isn’t a good idea for patients with large balding areas to cover. It’s an issue of supply verses demand. Planting too many follicular units in a small area will leave less available donor for other areas of the scalp. Thus, it’s critical to make the best use of the available donor hair supply and only add more hair to areas of great concern to the patient. Final Acknowledgements Though being an ISHRS member and attending the meetings doesn’t guarantee a surgeon is performing state of the art hair transplants with results, it appears that most physicians who regularly attend these conferences are dedicated to continually improving their technique and level of patient care. A special thanks to all those physicians who attended the meeting and are working for the best interest of patients. Surgeons who are recommended by this community who attended the meeting include: Dr. Scott Alexander Dr. Bernardino Arocha Dr. Alfonso Barrera Dr. Michael Beehner Dr. Robert M. Bernstein Dr. Tim Carman Dr. Glenn Charles Dr. Ivan Cohen Dr. Jerry Cooley Dr. Robert Dorin Dr. Jean Devroye Dr. Bessam Farjo Dr. Nilofer Farjo Dr. Bijan Feriduni Dr. Shelly Friedman Dr. Steve Gabel Dr. John Gillespie Dr. Edmond Griffin Dr. Robert Haber Dr. Victor Hasson Dr. Jim Harris Dr. Sheldon S. Kabaker Dr. Sharon Keene Dr. Richard S. Keller Dr. Raymond Konior Dr. Melike Kulahci Dr. William Lindsey Dr. Pathuri Madhu Dr. Ricardo Mejia Dr. Mike Meshkin Dr. Parsa Mohebi Dr. Humayun Mohmand Dr. Thomas Nakatsui Dr. Bernard Nusbaum Dr. Vladimir Panine Dr. William Parsley Dr. Damkerng Pathomvanich Dr. Vito Quatela Dr. H. Rahal Dr. Bill Rassman Dr. Bill Reed Dr. Tom Rosanelli Dr. Paul Rose Dr. Marla Rosenberg Dr. Paul Shapiro Dr. Ron Shapiro Dr. Cam Simmons Dr. Ken Siporin Dr. Martin Tessler Dr. Robert True Dr. Arthur Tykocinski Dr. James E. Vogel Dr. Jerry Wong If you are a physician recommended by this community and attended the annual 2010 ISHRS meeting and don’t see your name on the above list, please contact us we’ll be happy to add your name. Onwards and Upwards, Bill Seemiller and Patrick Hennessehy - Publishers of this Community
  15. I just got back from a follow-up interview with this "surgeon" one year after our surgery. The purpose of this post is to warn vulnerable prospects from becoming another victim to this professional salesman. Let me introduce you to the background: I'm 20, and I had my surgery with this doctor when I was 19. I had a somewhat receding hairline, with some small entries. The doctor suggested 1500 drafts for me. Here are some warning signs I ignored in my rush to get a surgery done (always a terrible mistake; seriously, folks, don't rush with this procedure): - The interview did not last more than 5-7 minutes. Their photo album only had 4 pictures of surgeries done. They rush in patients in and out. - They asked to set an appointment for the surgery, and the first topic to come was money. During the initial interview and the day of the surgery, they never went into specifics into what they were in fact going to do to me. - The day of the surgery, the surgeon was barely around. It was two women in nurse dresses who put in the grafts. 95%+ of the work was done by these women, not the surgeon. He came in once to inject me with more local anesthesia when I was feeling pain after the first hour of surgery on the incision of the back of my head. Results: - The hairs were put in sticking strictly up and straight. The sides of my head were done with the hairs standing up instead of coming out in an angular shape from the corner of the entry going downwards. It was not natural-looking. Separation between each hair is large; there is lots of transparency around the transplant area. - My hair came out kinky. Some of the frontline hairs are twisted and limp, and there are evens some 2-hair and 3-hair growths on the hairline. - The hairline on front is straight as a ruler. Same for the lines they did to cover the entry. No irregularity at all to create a natural look. My hair does not look natural. I have to side-comb it to cover the transplanted covers to the entries, because the transparency is so apparent and the hairline looks incomplete. Encounter with the surgeon: - I kept calling to set an appointment with the surgeon, as they never called me even 1 year after the surgery. They had no interest in follow-up. It took an entire month, as the doctor was never "available". When I was finally given the appointment and went, I waited an hour and a half to talk with the surgeon, despite the appointment being at 4 pm sharp. The discussion with the doctor did not last more than 6 minutes. The doctor told me that I was mistaken, that my surgery had been done fine, that all the other doctors (recommended by this site, by the way) that I had gone to for an opinion were just looking out to criticize, that they always do that. His descriptions of Dr's like Glenn Charles and Bernard Nusbaum were, and I quote this verbatim "Son unos comemierdas" (Translation from Spanish: They're all shit-eaters). He and the nurse he had brought in basically started to laugh at me when I explained that kinky hair growth on fine-haired men was often the result of poorly implanted grafts. He kept insisting that my hairline was fine, and I asked him if he'd be willing to put that to the test by asking for outside opinions. He said it was irrelevant. I was dismissed, they walked out. I didn't know whether to be furious or cry my eyes out at the arrogant treatment by this surgeon. I was duped out of hard-earned money, that they will certainly not reimburse. This doctor preyed on a desperate 19-year old, and he believes he can get away with it since he has appearances on TV and radio interviews. I want this to be a cautionary tale for prospects out there. I don't wish this feeling of devastation I am now feeling. You may contact me for corroboration.
  16. Recently, the Publishers of this community attended the 16th annual ISHRS scientific meeting held in Montreal from September 3rd to the 7th. See the official Press Release. Though many topics were discussed, this report will highlight topics that may be of most interest to hair loss sufferers. Many of these topics have been discussed and debated by patients for years on this hair loss forum. Topics include optimal hairline design and density, minimizing the appearance of the donor scar, using all follicular units (FUs) verses some multi follicular units (MFUs), FUE Megasessions, and complications with perpendicular (coronal/lateral) incisions and dense packing difficulties. There was a brief presentation on advances in hair biology discussing the latest research on cellular and molecular controls of follicular development and growth. However, because the Publishers of this community were not able to attend this presentation, this report won't contain any new information on this topic. The attention to detail at these meetings is certainly very impressive and surgeons who regularly attend deserve to be commended for their dedication to continuing education. Background on the ISHRS and Meetings The primary mission of the ISHRS (International Society of Hair Restoration Surgery) is to educate hair restoration physicians from the beginner to the master. It is by far the most prominent hair restoration professional organization in the world and the host of the five day annual scientific meeting. Their website (http://www.ISHRS.org) provides useful information about hair restoration and profiles and contact information for its 700 worldwide physician members. Many of the physicians well recognized by patients online for achieving excellent results have also become well known and respected by their colleagues as leaders and teachers in the industry. Many leading physicians recommended by this community led or were a part of every discussion panel. This year, Coalition member Dr. Arthur Tykocinski of Brazil did the hard work of chairing the meeting with help from his co-chairs. Last year's ISHRS meeting was chaired by Coalition member Dr. Sharon Keene of Tucson, Arizona. At the meeting, recommended surgeon Dr. Bill Parsley of Louisville, KY replaced Coalition member Dr. Bessam Farjo as the acting President for the coming year. Physician Recognition and Awards: The "Platinum" and "Golden" Follicle The "Platinum" and "Gold" follicle awards are the highest honors given to leading surgeons in hair restoration by the ISHRS at each meeting. These awards recognize outstanding achievement in basic scientific or clinically-related research in hair pathophysiology or anatomy as it relates to hair restoration. This year, two outstanding physicians have been recognized by their peers and given the highest honor of the "Platinum" and "Golden" follicle awards. A special congratulations to Coalition member Dr. Jerry Cooley of Charlotte, NC who received the Platinum follicle award and Coalition member Dr. Paul Rose of Tampa, FL who was given the Golden Follicle Award. These two surgeons have been recognized for years by their patients online for consistently producing excellent results. No wonder their peers have recognized them as leaders and teachers in the hair restoration field. Both surgeons were respectfully given a standing ovation by their colleagues. Based on the outstanding reviews online by their patients, had they been there, the applause would have shaken the foundation. Presentations at the ISHRS meeting of particular interest to Hair Loss Sufferers: Hairline Design and Optimal Density Natural hairline reconstruction is probably one of the most important factors considered by prospective patients and one of the greatest challenges hair transplant surgeons face on a daily basis. Combining numbers of grafts with artistic design, a surgeon must recreate an age appropriate, natural looking hairline with suitable density to achieve an optimal cosmetic improvement. Hairline Design In a hairline demonstration panel discussion led by Dr. Knudsen of Australia, a few top surgeons in the field including Dr. Ron Shapiro, Dr. Arthur Tykocinski, Dr. William Parsley, and Dr. Walter Unger presented their approach to hairline design on the same few patients for compare, contrast, and discussion. Though each hairline design was aesthetically pleasing to the eye, each hairline was uniquely and creatively crafted based on scientific principles of measurement and individual experience and artistry. Patients needing hairline reconstruction should discuss a surgeon's approach with those they are considering and look through patient photo galleries that demonstrate their artistry. Hairline Density High density hair transplants are often hyped online giving forum members the impression that surgeons who produce the greatest densities (in FU/cm2) are the best in the industry. But are higher densities always superior? What about in particular for the hairline? In a presentation and discussion led by Coalition member Dr. Sharon Keene on maximum verses cosmetic densities, a few leading hair restoration physicians presented varying densities. Surgeons representing the 35-45 FU/cm2 side of the debate include Coalition member Dr. Robert Bernstein, recommended physician Dr. William Parsley, and Dr. Walter Unger. On the 50-70 FU/cm2 side of the debate, Coalition member Dr. Thomas Nakatsui and recommended physician Dr. Melike Kulahci were represented. Each set of photos including those representing lower and higher densities were artistic with attention to detail. So the question remains, are higher densities necessary if lower densities can achieve the same cosmetic appearance? Where higher densities may be needed is when a patient steps under harsh lighting. Hair characteristics surprisingly were not discussed, but plays a huge role in the number of FU/cm2 needed to achieve proper hairline naturalness and density. Dr. Keene believes that studying natural hairline density in non-hair loss suffering patients is the only way to conclude appropriate density needed for the hairline. Dr. Keene suggests based on her anecdotal findings that natural hairline density in non-hair loss sufferers is only between 40-50 FU/cm2 on the average as opposed to the conjectured 80. If her findings prove accurate, surgeons may very well re-evaluate the need to densely pack greater numbers in such a small area. Before Dr. Keene feels comfortable drawing final conclusions however, she intends on increasing her sample size to at least 50 subjects. Creating an Optimal and Invisible Scar Minimizing the appearance of the donor scar is a high priority for most hair transplant patients and leading hair restoration physicians alike. That's why creating an optimal donor scar is a hot topic not only on our hair loss forum, but also amongst leading physicians at the ISHRS scientific meeting this year. The trichophytic closure technique has been labeled the "Gold Standard" by a number of leading physicians including Coalition member Dr. Robert Haber. This method involves trimming the edge of one side of the wound and overlapping the layers to complete the procedure. This allows non-harvested hair to grow through the wound, masking the appearance of the scar. But should the trichophytic closure technique be used during every hair transplant procedure? Coalition members Dr. Robert Haber and Dr. William Reed admit that there are always exceptions, but advocate its use in all cases "possible" since it increases the probability of a minimal scar. Coalition member Dr. Bill Rassman and recommended physician Dr. Michael Beehner argue that use of the trichophytic closure technique is best reserved for the "last" procedure in order to preserve scalp elasticity for subsequent procedures to come. Surgeons agree that the trichophytic closure technique is best implemented with minimal tension to reduce the risk of scar stretching. In the event of a difficult wound closure, even those presented advocates of always using the trichophytic closure technique will use a standard closure to minimize tension on the wound. It makes sense to preserve scalp elasticity for patients intending to have multiple procedures however, whether or not the patient will return for subsequent sessions is not guaranteed. All Follicular Units verses Mixed Grafts Since the advancement in hair restoration and the preference by many leading hair restoration physicians toward all follicular units (hairs as they occur naturally in the scalp), there has been some debate on whether or not it's acceptable to mix multi unit grafts (called MUGs) with follicular units (FUs) and still create a natural looking hair transplant. Multi unit grafts contain follicular units similar but distinct from minigrafts. However, when MUGs are carefully trimmed under microscopes into refined double follicular units (DFUs ??“ two distinct follicular units very close together) or follicular families (follicular units in close proximity), MUGs are often much smaller and can be easily camouflaged. Old school minigrafts are typically bulkier even though they may or may not contain the same number of hairs as MUGs. Arguments for using all follicular units include creating the most natural looking head of hair without appearing "pluggy" or "grafty" and the ability to densely pack grafts close together in a single session. Advocates of the occasional use of MUGs mixed with follicular units argue that the transplanted MUGs cannot be spotted in qualified patients, looks completely natural, and create a greater illusion of density. Coalition member Dr. Bill Rassman admits that using MUGs should be reserved for male patients with blond fine hair and in female patients where scalp to hair contrast ratio is minimal. He also notes that MUGs should also be used in minimal quantity. Some also feel that using some MUGs in patients with gray hair is acceptable. No surgeon on the panel advocated the use of all multi unit grafts to replace follicular units. Perpendicular (Coronal/Lateral) verses Parallel (Sagital) Incisions Perpendicular incisions (commonly referred to as the "lateral slit technique" or coronal incisions) have a number of cited advantages such as maximizing the shingling effect of the follicular units, increased dense packing, and optimizing angulation control of the hair from the scalp. However, as Coalition members Dr. Jerry Wong and Dr. Thomas Nakatsui pointed out in their presentation, there are a few complications to overcome with this technique. While parallel (sagital) incisions slide easily in and out between existing hairs, perpendicular (coronal/lateral) incisions increase the risk to transect existing hair if a surgeon is not extremely careful and accurate. Additionally, perpendicular incisions also tend to disrupt the scalps vasculature more than parallel incisions. Thus parallel incisions transect less hairs and blood vessels, assuming the same size blade. Disrupting the scalps vasculature can lead to an increased risk of avascular necrosis (a disease resulting from temporary or permanent loss of the bloody supply to the bones). Both Dr. Wong and Dr. Nakatsui noted that minimizing these risks include to avoid dense packing in areas of poor vasculature and to avoid making incisions too deep. Dense Packing Complications Large session high density hair transplants are desirable to patients since it typically limits the number of subsequent surgeries needed. And though a handful of leading hair restoration physicians have taken on this challenge when appropriate for the patient, some complications have been cited in a panel discussion led by Dr. William Parsley. Dr. Ron Shapiro and Dr. Michael Beehner shared their experience and expertise on this subject. One debated complication is graft survival at higher densities. Previous studies have been done on graft survival rates that indicate graft survival decreases when density increases. Whereas just about anyone can transplant higher densities, growth yield is debatable. The introduction of smaller blades to make recipient incisions has convinced many leading surgeons that higher densities may produce adequate growth yield, but not in all cases. Dr. Beehner believes that the staff's experience and ability to trim and place grafts safely into recipient sites plays major role in graft survival at higher densities. Dr. Ron Shapiro agrees but also believes that more scientific study is needed. Other complications include increased risk of necrosis, "shock loss" to existing hairs, abnormal distribution of hair in the event the patient loses more hair, and using an abundance of a finite donor source in a concentrated area. Most surgeons will agree that cases exist where extreme dense packing is suitable. But in many patients, lower density hair transplants are appropriate. FUE Megasessions vs. Strip Surgery Most surgeons feel that small sessions of follicular unit extraction (FUE) can be a viable solution for qualified patient candidates. But just as strip surgery has evolved over the years into larger "megasessions", some hair restoration physicians continue to push the envelope with FUE by extracting and planting more follicles in a single session. In a panel discussion on the controversy "Regular" strip vs. "Big" FUE sessions led by Dr. Kolasinski, a few vital issues were discussed. Those who took the "Regular Strip" side of the debate which includes Coalition member Dr. Jerry Wong and Dr. James Harris who is recommended cited a few disadvantages of FUE Megasessions. Unlike with strip whereby a "session" is usually defined by what is accomplished on a single surgery day, an FUE "session" is defined by how many grafts can be removed and planted over several consecutive days. Therefore, a 3200 FUE "session" may sound impressive, but if accomplished over 4 days, the clinic is only averaging 800 follicular units daily. Using the FUE technique, additional forces are placed on the follicle and are removed blindly. Follicle transection therefore, is often higher than with strip, lessening the number of viable hairs for transplanting. Cysts can also form in the donor area and impact the surrounding hairs. Those who took the "Big FUE Sessions" side of the debate cited a few disadvantages of strip. Strip surgery will undoubtedly produce an irreversible linear scar even though it can often be well camouflaged. The danger however, of future scar exposure may occur if a hair loss sufferer loses enough hair to become a level 7 on the norwood scale. No consensus has been reached regarding the viability and maximum hair growth yield when doing FUE megasessions. Therefore, until more proof is provided by physicians regularly performing them to their peers, this controversy will most likely continue. Final Acknowledgements Though attending the ISHRS scientific meeting doesn't guarantee a surgeon is producing excellent results, it appears that most physicians who regularly attend these conferences are dedicated to continually improving their technique and level of patient care. A special thanks to all those physicians who attended the meeting and are working for the best interest of patients. Surgeons who are recommended by this community who attended the meeting include: Dr. Bernardino Arocha Dr. Michael Beehner Dr. Robert M. Bernstein Dr. Tim Carman Dr. Glenn Charles Dr. Jerry Cooley Dr. Robert Dorin Dr. Jeffrey Epstein Dr. Herbert Feinberg Dr. Christopher Gencheff Dr. Edmond Griffin Dr. Robert Haber Dr. Jim Harris Dr. Sheldon S. Kabaker Dr. Sharon Keene Dr. Richard S. Keller Dr. Raymond Konior Dr. Bradley Limmer Dr. Ricardo Mejia Dr. Bernard Nusbaum Dr. William Parsley Dr. Vito Quatela Dr. Bill Rassman Dr. Bill Reed Dr. Paul Rose Dr. Marla Rosenberg Dr. Brandon Ross Dr. Paul Shapiro Dr. Ron Shapiro Dr. Ken Siporin Dr. Martin Tessler Dr. Robert True Dr. James E. Vogel Dr. Arthur Tykocinski Dr. Jean Devroye Dr. Bessam Farjo Dr. Nilofer Farjo Dr. Bijan Feriduni Dr. Melike K??lah?§i Dr. John Gillespie Dr. Thomas Nakatsui Dr. H. Rahal Dr. Jerry Wong If you are a physician recommended by this community and attended the annual ISHRS meeting and don't see your name on the above list, please respond to this thread or contact us at help@hairtransplantnetwork.com and we'll be happy to add your name.
  17. Like a lot of guys, I wanted to do something about my hair loss. Before I found this forum I had no idea where to go. I was more concerned with getting a quality procedure more than cost. My first consultation was with Bosley in Boca Raton, and my first instinct was that it was similar to buying a used car (down to the shifty salesman with less than stellar transplants himself). At Bosley they made it seem like it was a real treat for me to actually get seen by a doctor ??“ whereas usually that would only happen after I had committed to the surgery there. My next step was to get a consultation with a rep from MHR. Not only was there no doctor at that consultation to check my scalp and give me an idea for what I could expect, but the sales guy gave me expectations that even a novice like me knew were too flowery to be believable. Ironically, it was the salesman from MHR who pointed out that I should look on-line for critiques and reviews of MHR and other transplant doctors. When I came to this forum I found a ton of information that both eased my trepidation with the procedure as a whole and insightful warnings about going to "hair mills" that matched my gut feeling having been to the 2 different consultations. After reading over the hair transplant doctors in Florida I scheduled consultations with Dr. Bernard Nusbaum of the Hair Transplant Institute of Miami, Dr. Charles of the Charles Medical Group, and Dr. Jeffrey Epstein of the Foundation for Hair Restoration. What struck me initially was the fact that I was able to schedule appointments with all 3 within days of the call whereas Bosley and MHR required me to wait almost a month for a consultation. I must say that I was shocked at the degree of professionalism and candor that all three doctors showed in their respective consultations. I went from feeling like I was shopping for a used car (at the hair mills) to consulting a professional helping me make a potentially life-altering decision. It also struck me that neither Bosley nor MHR offered me a prescription for Propecia. All three of doctors I consulted with from this forum offered it and I promptly began using it. All three doctors gave remarkably similar presentations with realistic expectations. And without going into specifics (primarily because I don't remember them), all three doctors were markedly less expensive than either hair mill I visited (my guess is because they don't have the outrageous advertising budgets and salesmen commissions to cover). I have nothing particularly bad to say about Dr. Charles and Dr. Nusbaum. I chose to have Dr. Epstein do my procedure primarily because of the attention to care that I received from him and everyone in his office. The procedure was done May 7, 2008. I appreciated the fact that Dr. Epstein quoted me a flat fee instead of a per follicle cost (which might have left me wondering throughout the entire procedure how much this was going to cost). Truthfully it was initially a toss-up between Dr. Epstein and Dr. Charles, but Dr. Epstein's projected follicle transplant number was significantly higher and I personally preferred his results photos found on this forum. I don't remember what the exact breakdown was of the 1s, 2s, etc but my total was approximately 2,876 (which was higher than his initial estimate). Not that it was a deciding factor for me, but as soon as I first entered his office I noticed that every single person in Dr. Epstein's office was extremely personable. There aren't enough good things I can say about my experience with Dr. Epstein. The whole procedure went more smoothly than I could have imagined. I would urge anyone considering a hair transplant to consult several clinics/doctors, and I would personally recommend Dr. Epstein.
  18. Both patients and ethical physicians share the common goal of elevating the standards of the hair restoration profession. While this patient based community provides a forum for sharing and analyzing real results and the physicians who provide them, many physicians have worked to establish educational standards for the hair transplant profession. The most prominent effort by physicians to set standards and criteria for state of the art hair transplantation and practices has been the American Board of Hair Restoration Surgery (ABHRS) . This non profit organization is managed by hair restoration physicians and certifies physicians as "Diplomates" after they successfully demonstrate a high degree of knowledge about current hair transplantation by passing an extensive written and oral examination. Dr. Bernie Nusbuam Dr. Bernie Nusbuam, who is a very respected member of the Coalition of Independent Hair Restoration Physicians, will be assuming the Presidency of the ABHRS. I asked him to provide our community with more information about the ABHRS certification process and what it means. As he himself states, the ABHRS certification does not insure competence. But it does at least certify that ABHRS Diplomates have a demonstrated high level of understanding of current hair transplantation techniques and practices. The information Dr. Nusbuam provided to me is presented below: American Board of Hair Restoration Surgery (ABHRS) Update As a Coalition Physician and the incoming president of the ABHRS, I would like to inform the members of this community about this organization. Ten years ago, representatives from societies whose members perform hair restoration surgery (the American Academy of Cosmetic Surgery, the International Society of Hair Restoration Surgery, the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Dermatologic Surgery) established their commitment towards a process which would measure physicians' knowledge with regard to the safe and aesthetically sensitive practice of hair restoration. Their goal was to create a relevant, credible, unbiased examination that would help the profession and the public identify physicians who had attained a particular fund of knowledge in this regard. These founders selected a group of experienced hair transplant surgeons who were granted AB HRS certification and composed the first written and oral examinations which were administered in 1997. Since then, with the help of physicians who have passed the exam, a yearly oral and written examination has been developed and administered under the direction of a psychometric consultant (a Ph.D. who specializes in examining the reliability of standardized tests). The written examination consists of 200 questions and the oral examination presents the candidate with three difficult cases in front of two examiners. Topics covered include not only general principles and surgical technique, but , among others, proper aesthetics, repair techniques, medical therapy, management of complications, safe administration of anesthesia, identification of hair loss diseases that should not be transplanted as well as emergency management in the hair transplant setting. To date, 124 candidates representing 12 countries have been certified (given Diplomate status). Board certificates are time- limited, meaning that Diplomates, (including those who wrote the original test and did not take the examination) have to recertify every 10 years with strict Maintenance of Certification requirements in order to maintain their certification status. These requirements involve: 1) maintaining an unrestricted medical license and notification to the board of any current or past disciplinary actions 2) continuing medical education of at least 100 hours every three years of which 50% must be specifically hair related 3) passing a recertification exam (the first recertification exam is being given in September of this year and I will be one of the Diplomates who passed the exam in 1997 and will be taking the recertification exam this year) and 4) evaluation of practice performance by providing patient records for peer review. The ABHRS has also implemented regulations about how Diplomates can present their certification status in advertising or promotional materials. Diplomates have to comply with their local and state medical board regulations and cannot embellish their certification in any way. Diplomates who have misused their certification status in this regard have received notification demanding that they stop, or otherwise forfeit their certificates. There was some initial negativity towards the ABHRS and some criticism still exists. Some feel that the term "Board" was not a good choice because the ABHRS is not an ABMS (American Board of Medical Specialties) recognized board. Perhaps "subspecialty certificate" would have been a better choice but at least "board certification" is a term that everyone understands. Examples of ABMS recognized boards are the American Board of Dermatology, the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The ABMS system involves a minimum three year residency program and a subsequent examination. In a residency program, faculty members can evaluate a candidate for three years or more prior to the examination process. Unfortunately, at the present time, there are no residency programs devoted to hair restoration that can train and produce a competent hair restoration surgeon. In addition, there are no ABMS boards with an examination dedicated to hair restoration. I should mention that meetings have taken place with the ABMS and the American Board of Dermatology to discuss board certification in hair restoration surgery that would be ABMS recognized. While this may never be achieved, initial discussions were encouraging and efforts towards this goal will continue. A responsible field should stimulate its members to reach a higher educational level and knowledge base and then identify these physicians to the public .Since we do not have this option through the ABMS, the ABHRS is the best possible solution at this time. I have great respect for many of my colleagues who are excellent surgeons and leaders in the field of hair restoration who may or may not be certified by an ABMS board and do not feel the need to take the ABHRS exam. Many of us, however, who are ABMS board certified in other fields, felt that, achieving ABHRS certification was an important way to demonstrate our dedication and commitment to our patients and to the field of hair restoration. I can frankly state that the extensive time that I spent studying and preparing to take the ABHRS exam was one of the most rewarding educational experiences during my 25 year career with respect to gaining knowledge in this field and becoming a well-rounded hair restoration surgeon. Does ABHRS certification insure competency? Absolutely not! Also, as I mentioned earlier, there are top-flight physicians who are among the best hair restoration surgeons who are not ABHRS certified. Interestingly, 24 of the recommended surgeons on this site are ABHRS certified and 8 of us sit on the ABHRS Board of Directors. In 2005, the ISHRS, which is the largest educational society in hair restoration, conducted a survey of its members who were NOT ABHRS certified. With a 30% response rate, 70% of the responders felt that board certification is important to the field of hair restoration surgery and 72% indicated that they would like to be certified. 90% indicated the ABHRS is trying to serve the public and the profession. Just as the ISHRS provides the educational "arm" of this field, the ABHRS, through its efforts in providing a credible examination, serves as one component of the overall process and goal which we are all striving towards , that is, to improve the quality of our results and, in turn, help prospective patients. Thank you, Bernard Nusbaum, M.D.
  19. Both patients and ethical physicians share the common goal of elevating the standards of the hair restoration profession. While this patient based community provides a forum for sharing and analyzing real results and the physicians who provide them, many physicians have worked to establish educational standards for the hair transplant profession. The most prominent effort by physicians to set standards and criteria for state of the art hair transplantation and practices has been the American Board of Hair Restoration Surgery (ABHRS) . This non profit organization is managed by hair restoration physicians and certifies physicians as "Diplomates" after they successfully demonstrate a high degree of knowledge about current hair transplantation by passing an extensive written and oral examination. Dr. Bernie Nusbuam Dr. Bernie Nusbuam, who is a very respected member of the Coalition of Independent Hair Restoration Physicians, will be assuming the Presidency of the ABHRS. I asked him to provide our community with more information about the ABHRS certification process and what it means. As he himself states, the ABHRS certification does not insure competence. But it does at least certify that ABHRS Diplomates have a demonstrated high level of understanding of current hair transplantation techniques and practices. The information Dr. Nusbuam provided to me is presented below: American Board of Hair Restoration Surgery (ABHRS) Update As a Coalition Physician and the incoming president of the ABHRS, I would like to inform the members of this community about this organization. Ten years ago, representatives from societies whose members perform hair restoration surgery (the American Academy of Cosmetic Surgery, the International Society of Hair Restoration Surgery, the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Dermatologic Surgery) established their commitment towards a process which would measure physicians' knowledge with regard to the safe and aesthetically sensitive practice of hair restoration. Their goal was to create a relevant, credible, unbiased examination that would help the profession and the public identify physicians who had attained a particular fund of knowledge in this regard. These founders selected a group of experienced hair transplant surgeons who were granted AB HRS certification and composed the first written and oral examinations which were administered in 1997. Since then, with the help of physicians who have passed the exam, a yearly oral and written examination has been developed and administered under the direction of a psychometric consultant (a Ph.D. who specializes in examining the reliability of standardized tests). The written examination consists of 200 questions and the oral examination presents the candidate with three difficult cases in front of two examiners. Topics covered include not only general principles and surgical technique, but , among others, proper aesthetics, repair techniques, medical therapy, management of complications, safe administration of anesthesia, identification of hair loss diseases that should not be transplanted as well as emergency management in the hair transplant setting. To date, 124 candidates representing 12 countries have been certified (given Diplomate status). Board certificates are time- limited, meaning that Diplomates, (including those who wrote the original test and did not take the examination) have to recertify every 10 years with strict Maintenance of Certification requirements in order to maintain their certification status. These requirements involve: 1) maintaining an unrestricted medical license and notification to the board of any current or past disciplinary actions 2) continuing medical education of at least 100 hours every three years of which 50% must be specifically hair related 3) passing a recertification exam (the first recertification exam is being given in September of this year and I will be one of the Diplomates who passed the exam in 1997 and will be taking the recertification exam this year) and 4) evaluation of practice performance by providing patient records for peer review. The ABHRS has also implemented regulations about how Diplomates can present their certification status in advertising or promotional materials. Diplomates have to comply with their local and state medical board regulations and cannot embellish their certification in any way. Diplomates who have misused their certification status in this regard have received notification demanding that they stop, or otherwise forfeit their certificates. There was some initial negativity towards the ABHRS and some criticism still exists. Some feel that the term "Board" was not a good choice because the ABHRS is not an ABMS (American Board of Medical Specialties) recognized board. Perhaps "subspecialty certificate" would have been a better choice but at least "board certification" is a term that everyone understands. Examples of ABMS recognized boards are the American Board of Dermatology, the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The ABMS system involves a minimum three year residency program and a subsequent examination. In a residency program, faculty members can evaluate a candidate for three years or more prior to the examination process. Unfortunately, at the present time, there are no residency programs devoted to hair restoration that can train and produce a competent hair restoration surgeon. In addition, there are no ABMS boards with an examination dedicated to hair restoration. I should mention that meetings have taken place with the ABMS and the American Board of Dermatology to discuss board certification in hair restoration surgery that would be ABMS recognized. While this may never be achieved, initial discussions were encouraging and efforts towards this goal will continue. A responsible field should stimulate its members to reach a higher educational level and knowledge base and then identify these physicians to the public .Since we do not have this option through the ABMS, the ABHRS is the best possible solution at this time. I have great respect for many of my colleagues who are excellent surgeons and leaders in the field of hair restoration who may or may not be certified by an ABMS board and do not feel the need to take the ABHRS exam. Many of us, however, who are ABMS board certified in other fields, felt that, achieving ABHRS certification was an important way to demonstrate our dedication and commitment to our patients and to the field of hair restoration. I can frankly state that the extensive time that I spent studying and preparing to take the ABHRS exam was one of the most rewarding educational experiences during my 25 year career with respect to gaining knowledge in this field and becoming a well-rounded hair restoration surgeon. Does ABHRS certification insure competency? Absolutely not! Also, as I mentioned earlier, there are top-flight physicians who are among the best hair restoration surgeons who are not ABHRS certified. Interestingly, 24 of the recommended surgeons on this site are ABHRS certified and 8 of us sit on the ABHRS Board of Directors. In 2005, the ISHRS, which is the largest educational society in hair restoration, conducted a survey of its members who were NOT ABHRS certified. With a 30% response rate, 70% of the responders felt that board certification is important to the field of hair restoration surgery and 72% indicated that they would like to be certified. 90% indicated the ABHRS is trying to serve the public and the profession. Just as the ISHRS provides the educational "arm" of this field, the ABHRS, through its efforts in providing a credible examination, serves as one component of the overall process and goal which we are all striving towards , that is, to improve the quality of our results and, in turn, help prospective patients. Thank you, Bernard Nusbaum, M.D.
  20. Hello everyone, i have been thinking about this lately after i been reading several posts. there was one post about HT doctors in Chicago, and the only coalition doctor in chicago was Dr. Raymond Konior another post came up a female who went to a coalition doctor by the name of William Reed. now, i know they are coalition doctors, and Pat checked out their work before they became a coalition doctor, but i beleive their work should be out there more. besides not seeing their results on patients since i became a member in december 06, i have not see other coalition doctors works either. just to name a few Leonard E. Aronovitz, D.O. Glenn Charles, D.O Edmond I. Griffin Robert Haber, M.D Sharon Keene, MD(i think i only seen one work of hers and it wasnt too good, confirm?) Raymond Konior, MD Dr. Bernard Nusbaum Thomas Chung Wai William Reed Dr. Arthur Tykocinski not only should these doctors showcase their work for potential patients to see so they can get a feel of what to expect, it also keeps a good line of competition. competition from different doctors will benefit patients and doctors as doctors have a need to keep up with current techniques and patients benefit as they get better results. now i know you may be thinking, competition is bad for business right? well i dont think so in this case. The average price per graft is 3$ and has stayed at that constant price for quite a while, most ht doctors are booked in advance by 4 months(or so atleast i heard), which doesnt give a reason for ht doctors to need to decrease price from direct competition. also in this industry, price is one of the last things you look at, you are looking for quality results. Also the HT industry is expanding significantly, and there and more and more members on the Hair transplant network. H&W, Feller and a few other Doctors are booked months in advance and many people recommend people to have their work with these doctors, i just feel that we should widen our horizons and be able to recommend more doctors. with all that being said, i just feel a need that all coalition doctors post patient results at least once every 6 months. and last but not least, i couldnt see why these doctors would not want to do it, its basically like how i would say it, "free advertisement"?
  21. Hello everyone, i have been thinking about this lately after i been reading several posts. there was one post about HT doctors in Chicago, and the only coalition doctor in chicago was Dr. Raymond Konior another post came up a female who went to a coalition doctor by the name of William Reed. now, i know they are coalition doctors, and Pat checked out their work before they became a coalition doctor, but i beleive their work should be out there more. besides not seeing their results on patients since i became a member in december 06, i have not see other coalition doctors works either. just to name a few Leonard E. Aronovitz, D.O. Glenn Charles, D.O Edmond I. Griffin Robert Haber, M.D Sharon Keene, MD(i think i only seen one work of hers and it wasnt too good, confirm?) Raymond Konior, MD Dr. Bernard Nusbaum Thomas Chung Wai William Reed Dr. Arthur Tykocinski not only should these doctors showcase their work for potential patients to see so they can get a feel of what to expect, it also keeps a good line of competition. competition from different doctors will benefit patients and doctors as doctors have a need to keep up with current techniques and patients benefit as they get better results. now i know you may be thinking, competition is bad for business right? well i dont think so in this case. The average price per graft is 3$ and has stayed at that constant price for quite a while, most ht doctors are booked in advance by 4 months(or so atleast i heard), which doesnt give a reason for ht doctors to need to decrease price from direct competition. also in this industry, price is one of the last things you look at, you are looking for quality results. Also the HT industry is expanding significantly, and there and more and more members on the Hair transplant network. H&W, Feller and a few other Doctors are booked months in advance and many people recommend people to have their work with these doctors, i just feel that we should widen our horizons and be able to recommend more doctors. with all that being said, i just feel a need that all coalition doctors post patient results at least once every 6 months. and last but not least, i couldnt see why these doctors would not want to do it, its basically like how i would say it, "free advertisement"?
  22. I am one to worry, especially when it comes to getting a procedure done that is not medically needed and only done to look and feel better about yourself. It took 5 years of research, and more and more hair falling out before I went for it. I don't regret for one second in deciding to go for it. It was done all in one session. Procedure Date: August 11,2006 Follicular Units: 2501 Hair Counts: 525 (1's) 1075 (2's) 901 (3's+4's) I had the magical hands of Dr. Bernard Nusbaum that made such great results possible. See the before and after Pics. The after Pics are 6 months after the procedure. I will post more current pics when I find my camera. Dr. Nusbaum is in Coral Gables, Fl. at 305-448-9100. I recommend him highly not only for the great results but also for the professional manner in which everything was done. From the consultation through the follow ups. Great Doctor!!!
  23. My great Doctor is Dr. Bernard Nusbaum. More Pics.
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