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Found 29 results

  1. @Dr. Thomas Nakatsui beautiful and very natural, can you also see some photos of the procedure and the donor area?
  2. Welcome! Have you checked out our list of recommended physicians? You can easily search by geographic area. Here is a list of all the surgeons we recommend in Canada. Dr. John Gillespie Dr. Victor Hasson Dr. Thomas Nakatsui Dr. H. Rahal Dr. Jerry Wong Here is some information about how we recommend hair transplant surgeons.
  3. Hi, This is a patient who wanted some thickening of the frontal scalp and a little in the crown. We transplanted 703 single grafts, 1687 double grafts, and 810 big grafts, for a total count of 3200 grafts in one session. The postoperative photos were taken about two years after the transplant. Dr N PREOPERATIVE PHOTOS IMMEDIATE PRE-OPERATIVE PHOTOS WITH PLAN IMMEDIATE POST-OPERATIVE PHOTOS TWO YEARS POST OP PHOTOS Thomas Nakatsui, MD FRCPC
  4. trevsutt, Welcome! The nearest recommended physician to you is probably Dr. John Gillespie. If you are open to traveling a little farther you may want to research some of the other world-class hair restoration physicians we recommend in Canada. Dr. Victor Hasson - British Columbia Dr. Thomas Nakatsui - Alberta Canada Dr. H. Rahal - Ontario Canada Dr. Marla Rosenberg - Ontario Canada Dr. Cam Simmons - Ontario Canada Dr. Jerry Wong - British Columbia Canada Best of luck!
  5. Dr. Thomas Nakatsui discusses the services and procedures he provides his patients, including non-surgical and surgical hair loss treatments. This includes Propecia, Rogaine (minoxidil) and state of the art hair transplant surgery. At this time, Dr. Nakatsui does not provide laser therapy treatments.
  6. Dr. Thomas Nakatsui discusses his and his hair transplant clinic's strengths including the use of the advanced lateral slit technique, follicular unit hair transplantation and dense packing.
  7. Dr. Thomas Nakatsui discusses his medical background and how he got involved in performing today's state of the art ultra refined follicular unit hair transplantation and the lateral slit technique.
  8. Dr. Thomas Nakatsui discusses his philosophy on patient care and providing his patients with the best hair transplantation results.
  9. Dr. Thomas Nakatsui discusses what he finds most gratifying about performing today's state of the art ultra refined follicular unit hair transplantation
  10. Dr. Thomas Nakatsui discusses how to produce the best hair transplant results including creating the perfect hairline, dense packing, etc.
  11. In this hair transplant video interview, Coalition hair restoration physician Dr. Thomas Nakatsui describes how his practice and clinic evolved and now performs hair transplant megasessions with ultra high densities when appropriate for the patient.
  12. In this hair transplant video interview, Coalition hair restoration physician Dr. Thomas Nakatsui provides tips to hair loss sufferers considering hair transplantation on selecting a quality surgeon.
  13. In this hair transplant video interview, Coalition hair restoration physician Dr. Thomas Nakatsui discusses why researching and interacting with veteran patients on the Hair Transplant Network patient driven community is vital for patients considering surgical hair transplantation.
  14. ♠genius130, I know you specifically asked about Toronto area surgeons but here is a list of all of our Coalition and recommended hair restoration physicians in Canada for your review. Dr. John Gillespie - Alberta Canada Dr. Victor Hasson - British Columbia Canada, Coalition Member Dr. Thomas Nakatsui - Alberta Canada, Coalition Member Dr. H. Rahal - Ontario Canada, Coalition Member Dr. Marla Rosenberg - Ontario Canada Dr. Cam Simmons - Ontario Canada, Coalition Member Dr. Jerry Wong - British Columbia Canada, Coalition Member To learn about our criteria for recommending physicians, click here.
  15. T.C, Thanks for the interesting information. This is the type of information many people would like to hear (including myself) rather than getting bashed from a simple question. Although I do respect Spex opinion. My apologies if I have offended someone with the wrong choice of words. Having said that, I didn't meant to say "shave my head" (skin type) but rather than cut it short (like a buzz cut) as MusoInOz pointed out. Doesn't know ultra refined hair transplantation is the same as FUE. I am interested getting a consultation with ultra refined hair transplantation specialist Dr. Thomas Nakatsui.
  16. 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
  17. Hi, I have been following this forum for awhile and I still haven't seen alot of post for Dr. Nakatsui in Alberta, Canada. So far i see one or two that had transplant by Dr Nakatsui and the pictures look like they are back in the 80's. If you recently had your hair transplant by Dr. Nakatsui, please post your comments and pictures. I would like to gather as much as information before driving 400km to see him. Does anyone know if the price has changed recently especially with the economy?
  18. Is Dr. Alan Feller available in Canada? or anyone that's nearly as good and experienced as he is? I am looking for an FUE Docter in Canada who can transplant 2500 "FUE" grafts to restore hairline. Density 45/cm2 May be Dr. Thomas Nakatsui??? Dr. Rahal doesn't do that many grafts in FUE and Dr. hasson & wong don't perform FUE at all.
  19. It's not that dr feller won't perform the surgery it's just that i don't want to travel to the US from Canada, let alone to Belgium. I am trying to find any doctors in "Canada" that are equally as good as Dr Feller when it comes to "FUE" procedures. What are your opinions on Dr. Thomas Nakatsui? I can't find any recent FUE's he's done I appreciate you responses.
  20. Below I provided an excerpt of my summary of the topic of Coronals verses Sagitals from the Annual 2008 ISHRS Scientific Meeting in Montreal 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. Best wishes, Bill
  21. 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.
  22. Hi, I am 36 years and my hair is starting falling three years ago. Now its noticeable and i am starting looking into hair transplant. I have tired propecia for a year and now i am on Rogaine. I don't see any improvement or stabilize my hair falling. Through this website i was able to search two surgeon in my area and was wondering if anyone had any experience with either one of them and their techniques. Any recommendation with other surgeons would be great as well. Dr. Nakatsui performs large sessions of ultra refined follicular units using the lateral slit technique with extremely natural results. Thomas Chung Wai Nakatsui, MD Suite 200, 9670 - 142 Street Edmonton Alberta Dr. John Gillespie exclusively performs all microscopically prepared follicular unit hair transplantation with excellent results. Gillespie Hair Restoration Clinic 5116 ??“ Elbow Drive SW Calgary Alberta
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