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  1. I am considering Dr. Sam Lam, Dallas, Dr. Bernardino Arocha in Houston and Dr. Dan McGrath in Austin. I have met or talked with each and have been impressed until I come across negative reviews about any. Bottom line I would only feel the best talking to someone that had the surgery for similar FUT graft amount (1000-1200) for front side density but don't know anyone. Has anyone here actually had the procedure from them or know firmly about someone that has? Any help would be appreciated. Side note: for what it's worth, I had FUT done 20 years ago by Bosley and was probably going back to them until I met again with them and saw the numerous negative reviews here that reflected my same experience in just the basic communications with them through and past consult. TERRIBLE customer-service, no empathy, just focused on getting you signed up and they bad-mouth other locations of their own company!! For that I thank this forum for opening my eyes and causing me to cancel what would have been a nightmare.
  2. So I'm 6 months in with my FUT from Dr. Arocha. I had my FUT done on Nov 21st of 2014 at his office in Houston. I have nothing negative to say about the experience, other than I wish I was a little more prepared for the scar. But hey, it is worth it if I get the desired results. I am 37 years old, started thinning in my mid-late twenties. Started on finasteride at age 26 and still continue to this day (no side effects). Finally decided to take the plunge with Dr. Arocha and did a mega session of 4070 grafts. I did post-op follow up as well as 2 months in, going to back for another visit soon. All indications that everything went fine and he was very positive about how the results would end up. However, I am 6 months in and I am starting to get nervous. I have seen a little bit of growth, but not nearly what I have seen from others with this amount of grafts at this stage. Everyone says you should have more than 50% growth by month 6. Is that true? Please take a look at my pics and tell me I'm just being paranoid. Pics below are 1 day after surgery.
  3. Dr. Arocha has been showing his ultra refined and large sessions of follicular units on this forum as a recommended physician for well over a year. Given these many impressive results, it came as no surprise when visiting his clinic to see that his technique and procedure are truly ultra refined. However, I wanted to see it for myself and verify this before considering him for membership in the Coalition of Independent Hair Restoration Physicians. In my opinion he and his experienced staff have shown that they meet the demanding criteria and standards for membership in the Coalition. See Coalition standards at http://www.hairlosslearningcen...ership-standards.asp Dr. Arocha's beautiful office studio is part art studio and part clinic, combining his interest in medicine with his talent for painting. This synergy is evident in his patient's final results, which are typically very natural. Like so many patients I encounter during my clinic visits, the patient during the day of my visit did most of his research on the Hair Transplant Network. I enjoyed speaking with him and found him to be very well informed about hair transplantation. But what do you expect from someone who's a regular on this community 🙂 This patient in his early 40's wanted to restore and strengthen his hairline. To meet his goal of restoring a dense and natural hairline, Dr. Arocha and his staff intended to transplant approximately 3,000 follicular unit grafts. I really liked Dr. Arocha's donor removal technique. He first scored the surface of the patient's scalp with a single blade rather than cutting all the way down past the base of the follicles, which can result in transecting (severing) the underlying follicles. Once the scoring incisions were done, he used his forceps to gently separate the follicles in the donor strip away from the underlying donor area. This minimized the chance of transecting the precious donor follicles along the edge of the donor strip. Dr. Arocha also only took out one section of donor tissue at any given time so as to minimize the time the donor tissue and follicles were out of the body. Then when the medical techs were completing the trimming of a donor section a new section would be removed for trimming. Ultimately the donor tissue in total measured 1.2cm wide by 22cm in length. Dr. Arocha closed the donor area by first using internal sutures to pull the subcutaneous tissues beneath the skin together. This greatly reduces the tension on the surface of the skin so it can be sutured together under minimal tension. Thus there is less tension and pulling on the external skin level sutures, which reduces the chances of stretching and scaring along the donor scar. The sutures are also more comfortable for the patients than either staples or single layer closure. While doing such a double layer closure takes more time, I think it is optimal for the patient's healing and comfort. If I were to do another surgery, I personally would request a double layer closure. Dr. Arocha also performs the trichophytic closure technique when he expects the surgery to be the patient's last procedure. He also took care to only shave the donor area that was removed so that the patient's hair right above the suture line could easily cover it. Three of Dr. Arocha's medical techs ??“ Craig (9 years experience), Maria (10 years experience) and Lourdes (8 years experience) trimmed the donor tissue into follicular unit grafts, while Dr. Arocha made all the incisions for the grafts. He used the smallest incision that would accommodate the tiny grafts, while varying the angle and direction to replicate a natural hair direction. The final graft and hair count was 572 one hair grafts, 984 two hair grafts, 921 three hair grafts, 391 four hair grafts and 187 five hair grafts ??“ for a total of 3,055 grafts comprised of 7,802 hairs. In addition to performing a truly ultra refined top notch hair transplant procedure, I was impressed by Dr. Arocha's friendly 'bedside manner' and sense of humor. In my opinion, Dr. Arocha and his experienced staff have achieved the skill, experience and ultra refined procedure that puts their clinic on a world class standing. To learn more about Dr. Arocha, visit his profile/recommendation at http://www.hairtransplantnetwo...Doctors.asp?DrID=636
  4. Hello everyone ... I am living in Chicago and I decided to do hair transplant. I did a lot of research I found these two surgeon's result perfect and I do not have any problem travailing across country. So, could you please help me with one of these two doctors. which you recommend : 1- Dr. Bernardino Arocha 2- Dr. Raymond Konior I really appreciate your help..... Many thanks
  5. Welcome HouTx....the first and easiest thing I would do is make an appointment with a talented hair transplant surgeon based right in Houston. Dr. Bernardino Arocha can offer you sound advice during a consultation at his new state of the art facility in Houston. Dr. Arocha is one of the recommended surgeons on this site. Hair Loss Houston Dallas Austin TX Arocha Hair Restoration
  6. In this hair transplant video interview, Coalition hair restoration physician Dr. Arocha discusses how hair transplantation has restored the confidence in hundreds of patients he's performed hair transplant surgery on.
  7. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses the importance of developing a long term strategic hair restoration plan and using state of the art techniques to get the best hair transplant results.
  8. Thank you for your recommendation! Dr. Arocha has the expertise and artistic skills to help create a solution that can maximize hair restoration in crown area. Crowns are one of his specialties. Please refer to this article written by Dr. Arocha on the crown area. Principles of Crown Hair Restoration - 31-May-09: Houston Hair Transplant, Houston Hair Restoration article: contact Bernardino Arocha, M.D., ABHRS Also, feel free to browse our before and after patient result galleries. Photos - 2079 FUT, Crown Restoration, 9 month result on Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX Photos - Artistic Hair Restoration: Crowns on Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX Please feel free to contact us if you have any additional questions. Best wishes, CeCe CeCe@arochahairrestoration.com
  9. Watch4Norwoods- Thank you for your recommendation of Dr. Arocha and Arocha Hair Restoration. We appreciate it! Georgecontanza- Dr. Arocha has the expertise and artistic skills to create a solution that maximizes your hair restoration outcome in the crown. Please review this article that Dr. Arocha wrote about Crown Restoration: Principles of Crown Hair Restoration - 31-May-09: Houston Hair Transplant, Houston Hair Restoration article: contact Bernardino Arocha, M.D., ABHRS Also, we have several Before and After results posted on our website of previous crown restoration patients. I have added the links to our albums below. Photos - 2079 FUT, Crown Restoration, 9 month result on Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX Photos - Artistic Hair Restoration: Crowns on Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX Please let me know if you have any additional questions. We are here to help! Best wishes! CeCe Cece@arochahairrestoration.com
  10. Hello Inexorable81, Sorry to hear that this has happened. I am not sure who you are, but please understand we sincerely regret that this has happened. Unfortunately, we have not received any of your emails. We recently switched over to a Comcast Business service and are having problems with our phone and internet service today. Dr. Arocha takes his consultations seriously and to this extend he performs them personally. He does his best to educate and tailors the consultation to the patient's needs.He is available to answer any further questions either by phone or through emails. Usually,when patients come to see us they have done their homework by going on our website and going on this forum and checking out our before and after results. Below you will find a link to our Before and Afters on our website: Photos - Houston Hair Transplant, Houston Hair Restoration for Arocha Hair Restoration in Houston Texas US Photos - Hair Transplant Dallas for Dallas Hair Restoration in Dallas, TX Bernardino A. Arocha, M.D., ABHRS Hair Transplant Surgeon in Houston, Texas https://plus.google.com/+ArochaHairRestorationHouston/about?hl=en'>https://plus.google.com/+ArochaHairRestorationHouston/about?hl=en'>https://plus.google.com/+ArochaHairRestorationHouston/about?hl=en'>https://plus.google.com/+ArochaHairRestorationHouston/about?hl=en dr. arocha - Forum By and for Hair Loss Patients - Threads Tagged with dr. arocha In the meantime, here is Doctor Arocha's personal email is: barocha@msn.com. Please feel free to send him an email. Here are some links to what our patients are saying about their experience at Arocha Hair Restoration: https://plus.google.com/+ArochaHairRestorationHouston/about?hl=en Arocha Hair Restoration in Houston, TX - Reviews, Photos, and Directions Arocha Hair Restoration in Dallas, TX - Reviews, Photos, and Directions There is a lot of further information on our web sites, please let us know any further questions or if we can be of assistance. Kind regards, CeCe CeCe@arochahairrestoration.com
  11. Dr. Bernardino Arocha, M.D. and his experienced staff have performed ultra refined follicular unit hair transplantation exclusively for the past few years. They regularly perform surgeries exceeding 3,000 FU grafts per session, with their largest session to date being 6,000 grafts. Dr. Arocha is a Diplomat of the American Board of Hair Restoration Surgery and has performed over 2,000 hair transplant surgeries. I welcome all input and comments from forum members regarding his potential recommendation on the Hair Transplant Network. Given Dr. Arocha's extensive experience and his ultra refined techniques, I believe that once he garners sufficient positive feedback on this forum from actual patients he should be considered for membership in the Coalition of Independent Hair Restoration Physicians. To view the membership standards for the Coalition, click here . I asked Dr. Arocha to share photos of both his patient results and his surgery. He and his lead medical tech, Craig, have provided this community with numerous photos to demonstrate their ultra refined follicular unit procedure and its impressive results. View some of their patient photos below: 4032 Follicular Unit Graft ultra refined session 4,000 plus follicular units in two sessions 7 months after 3,000 plus grafts in one session Hair restoration into area scarred by burns Before and after photos for several different patients Surgery Photos: Graft preparation http://www.hairrestorationnetwork.com/eve/showthread.php?t=146226 Incision and graft placement Donor closure and pencil thin scar photos View additional patient photos on Dr. Arocha's website. Thanks for everyones input. Best regards, Pat ??“ the publisher of the Hair Transplant Network and the Coalition Hair Loss Learning Center
  12. Hi guys, I was just going through this thread and thought of giving my opinion on this topic. I am in my late twenties and have suffered from extreme hair loss! And that's why I can understand what people go through when they start having hairloss. I want to share my experience in this thread so that I can help you in some way to counter your hairloss by choosing the right doctor. I used to be very depressed about my terrible hairloss until I met Dr. Bernardino Arocha (from Texas) about 4 years back. In the last 3 years, I have had 3 FUT transplant procedures with him to counter my hair loss, and very recently, I also had a FUE procedure. And for all my 4 procedures (including the FUE), I have gone to Dr. Arocha, despite the fact that every time I had to travel over 2000 miles across the US to reach his clinic in Houston, Texas. During each of these procedures, he has done a fantastic job, which is evident from the results I have got. He has now brought big smile to my face! This, I guess, speaks volumes about the ability of Dr. Arocha and his staff in the domain of hair transplant (both FUT and FUE)! For FUE procedures, he has the ability to perform them using the ARTAS robot (which he owns) as well as using his 0.8mm manual punches, which I personally think is great, as he has complete control over the procedures! Well, if I have to describe Dr. Arocha in short, I would say that he is an ideal mix of “passion” and “compassion” – he has tremendous passion for the work he does and has a lot of compassion for his patients like us who are suffering from hair loss. Going down the memory lane 4 years back, I can remember that it was not easy for me to find a “quality” surgeon for my transplant procedure. The usual questions kept haunting me – Who is the best in this kind of work? What about the cost? What about the pain in the surgery? What about the healing? And most importantly, what about the final results? I am a Research Engineer by profession and thus by habit, I started doing quite an extensive research on hair transplantation and the surgeons who perform these surgeries. From all the studies that I did, I finally came to the conclusion that Dr. Arocha stands much ahead of his fellow peers in the hair transplant industry!! Plus, from my own experience with him in the last 4 years, I can mention so many positive points about him, which will surely make one feel that he is the right doctor to have a hair transplant with. Here are the points – (1) He is recommended by several surgical Hair Restoration Associations, as he has really set a very high standard for this kind of a surgery. I would suggest you to visit his website or the Hair Restoration Network forum for more details on his credentials, surgery results, and reviews, if you want. (2) He does skype as well as face-to-face consultation, both free of cost! He and his staff are very friendly. (3) Doc himself is very experienced and knowledgeable in hair transplantation and he has also completed a prestigious fellowship in hair transplantation to master the skills and intricacies involved in this kind of a surgery. On top of that, he has got a very knowledgeable, experienced and skillful staff. He keeps travelling to attend conferences and seminars on hair transplant surgeries to keep himself updated with the latest standard practices. (4) Doc is an artist himself by hobby and what I know about this kind of cosmetic surgery is that, along with the technical skills, the doc needs to have a very good aesthetic sense, because after all, its all about looks, which I am sure Dr. Arocha has. (5) Dr. Arocha and his staff concentrate on hair transplant and perform only ONE surgery a day, so the patient will be his sole attention on the day of your surgery. (6) Believe me, the surgery he performs is definitely painless, and most of the cases he deals with show early results. By God's grace, I am one of them! Hence, if you are considering a hair transplant to look better and younger, I would say that Dr. B. Arocha is definitely “the right” doctor for you! You even have an added advantage that you need a doctor in Dallas, and Dr. Arocha has a clinic right there in Dallas as well as Houston! So, you dont even need to spend time, energy and money in travelling, whereas you can be under the care of one of the best HT (FUT/FUE) surgeons in the world!
  13. Dear Forum Members, Dr. Bernardino Arocha has been showing examples of his large ultra refined hair transplant sessions on this forum since he was approved for recommendation in December, 2007. His dedication to patient education is also demonstrated by the extra time he spends answering hair loss questions and educating patients on our forum and popular Hair Loss Q&A blog. Before considering Dr. Arocha for the Coalition of Independent Hair Restoration Physicians, we wanted to verify that he and his staff met our demanding criteria and standards set by this community. To view the Coalition standards, click here. Thus, Pat recently visited and observed Dr. Arocha in surgery. To see highlights of Pat's visit, view 'Visit to Dr. Bernardino Arocha's Clinic in Houston, TX'. After observing Dr. Arocha and his staff's meticulous surgical techniques, Pat feels that Dr. Arocha is truly doing ultra refined work. Dr. Arocha has the experience, skill, and staff necessary to perform over 3000 follicular unit grafts in a single session, his largest of which to date is 6000 follicular unit grafts. He has performed over 2,000 hair transplant surgeries and is a board certified diplomate of the American Board of Hair Restoration Surgery (ABHRS). To learn more about Dr Arocha's experience, technique and philosophy, visit his Hair Transplant Network recommendation profile. Given Dr. Arocha's extensive experience and dedication to ultra refined densely packed hair transplants, we believe it's time to consider him for the Coalition. We welcome all input and comments regarding his potential inclusion. View some of his recent patient photos below: 2500 Graft Densely Packed Session with Dr. Arocha 3500 Grafts with Dr. Arocha 3000 Grafts with Dr. Arocha 2877 Grafts with Dr. Arocha 4025 Grafts with Dr. Arocha 3000 Grafts with Dr. Arocha 3053 Grafts with Dr. Arocha Donor Scar Photos with Dr. Arocha Several additional examples of Dr. Arocha's ultra refined work can be found in the Results Posted by Leading Hair Transplant Clinics forum. We look forward to your feedback. Best wishes, Bill
  14. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses his medical background and how he became involved in performing state of the art ultra refined follicular unit hair transplantation.
  15. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses what he finds most gratifying about performing hair transplantation.
  16. n this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses the importance of physician involvement in patient care during and after hair transplantation surgery.
  17. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses how he helps hair loss sufferers develop realistic expectations with hair transplantation and how he exceeds them.
  18. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses the importance of patients doing diligent research on the hair transplant procedure and the physicians who perform it.
  19. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha provides tips to hair loss sufferers considering hair transplantation on how to select a quality hair restoration physician.
  20. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha explains why his hair loss patients can expect undetectable natural looking hair transplant results with maximum hair growth yield.
  21. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses what drew him to perform surgical hair transplantation.
  22. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses the strong points of his hair transplant clinic and why experience and patient focus are vital to a successful hair transplantation.
  23. In this hair transplant video interview, Coalition hair restoration physician Dr. Bernardino Arocha discusses the passion and skill he and his hair restoration clinic has in performing today's revolutionary hair transplantation procedures.
  24. Thanks Bill those are some very good points. Dr. Arocha is in quite a few "top five lists." These lists vary amongst the different members of the community. You can check more about it here:Bernardino A. Arocha, M.D., ABHRS Hair Transplant Surgeon in Houston, Texas For a different perspective from another angle, one can Google hair transplant reviews in either Houston or Dallas to learn what actual patients who have gone through the procedure have to say. Hope this helps, Richard11
  25. 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
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