Visit to Dr. Chang's NHT Medical Clinic in Newport Beach, CA

[Pat - Community Publisher]

Over the years I had viewed the many impressive photos on Dr. Steven Chang's Natural Hair Transplant Medical Center website at www.hairtransplant.com. His patient's seemed to be achieving both natural and full looking results. But I was hesitant to recommend him our community since he does not do follicular unit grafting exclusively.

 

However, over the years I have come to realize that the greatest limiting factor in pure 1, 2, 3 and 4 hair follicular unit grafting is the ability to achieve the appearance of fullness. Even with large sessions using large numbers of follicular unit grafts it can still be difficult to achieve an illusion of density and fullness in the central/mid scalp regions. Typically the biggest complaint that patients potentially have with pure follicular unit grafting is that the density and fullness are not sufficient.

 

Leading surgeons like Dr. Ron Shapiro are very aware of this limitation and today often use a limited amount of "Multiple Follicular Units" in the mid scalp areas in and around follicular units to create an optimal illusion of density.

 

These multiple follicular unit grafts typically contain two or even three follicular units that are naturally close together. Thus such multi haired grafts are able to achieve a higher density of hair than can be achieved by placing separate follicular unit grafts into even the most densely packed incisions. These denser grafts can break up and mask what might otherwise be a see through or transparent looking hair transplant.

 

Dr. Chang believes in using three types of grafts ??“ micro grafts (single hair grafts), follicular units and what he terms "modified follicular units" (to learn more about these modified follicular units, click here). These modified follicular units are basically the same as "multiple follicular units" and contain typically 3 to 6 hairs per graft.

 

Like an artist using various sized brushes Dr. Chang believes he can create the optimal combination of naturalness and density by using these various grafts.

 

He also believes that it is important to minimize the amount of trimming to the donor tissue to avoid both damage to the follicles and the loss of hair follicles that are in the telogen phase in which they are virtually invisible even under microscopes (Note - at any one time approximately 10% of a patients hairs are in this invisible telogen resting stage).

 

During my visit Dr. Chang removed a donor strip from the patient that was 1 cm wide by 32 cm long. From this strip his staff produce approximately 1,500 grafts of which some were "modified follicular units" containing 3 to 6 hairs. To see photo highlights from this surgical visit, click here.

 

Based on watching he and his conscientious staff perform surgery I believe they have achieved a high level of competence in performing his technique. The clinic's five primary technicians - Atsuko, Keiko, Jamie, Chely and Angie - each have more than ten years experience in hair transplantation. Dr. Chang opened his clinic, Natural Hair Transplant Medical Center in 1994 and performs hair transplantation exclusively. He has also attended and contributed to ten of the last ISHRS international meetings.

[the B spot]

Pat,

 

Thanks for the write up of Dr. Chang.

 

Question: Are you inviting Dr. Chang for membership in the Coalition?

 

Thanks

J

[Pat - Community Publisher]

B Spot,

 

I think Dr. Changs work is strong in producing density and fullness in particular. But his current procedure generally does not create the small incisions and grafts to enable him to produce the ultra refined and dense follicular unit grafting required for Coalition Membership.

 

All the best, Pat

[John_in_NC]

1500 grafts out of a 32x1 cm: assuming the patient had 90 grafts/cm2 that should be almost double. I am glad I didn't go there.

[the B spot]

I had the same thoughts, just wanted to see where you stood.

Thanks Pat!

[M&M]

I posted this on the actual 'photos' section, but thought I may as well post my thoughts here also:

 

Pat,

 

I hold you in high respect as you, this site and its members are the reason I changed my opinion of transplants and went from thinking Bosley was 'state of the art' to knowing they are not as they still perform Mini & Micro grafts.

 

However, I'm confused as I read your writeup of Dr. Chang. In it, you mention that he still performs Micro Grafts along with follicular units. Aren't micro grafts seriously outdated?

 

I am also puzzled with the low graft count. Only 1500 grafts on a patient that appears to be a NW6 (at least), appears to be an extremely low number that will not produce a significant visual difference. Yet - there is no mention of it as any concern.

 

The post-op photo also appeared 'unnatural' (based upon what I have seen from the likes of Dr. Shapiro, H&W, etc.). The hairline also looks rather 'straight-lined' with all of the graph incisions larger than I am used to seeing. In all, I question whether the patient will experience much of a visual difference from such a small procedure over such a large surface and how natural it will appear given the obvious transition from follicular to micro grafts.

 

I clearly wasn't there to see the surgery performed, but wanted to share what I think based upon the photos and write-up. I suppose my main question is: Are these visitations to clinics meant to be fully objective and critical (like you and others are when people post photos on this site) or just 'positive commentary'?

 

Please don't take this in a negative way, as I am seeking input and hoping that this site remains truly objective.

[the B spot]

M---- I think that Pat is saying in a nice way that Dr. Chang is not performing state of the art hair transplantation.

 

In my opinion, ONE look at the recipient sites is enough for most to make an informed decision.

 

We also have to understand that in the future Dr. Chang may understand the necessity to perform ultra-refined transplants.

 

In addition, it is Pat's responsibility to describe his experiences as well as post photos of the surgeries he has viewed.

 

M, I think it is important that we continue to look to other clinics because Pat has been able to find several HT docs doing great work, AND, identify several who are not.

 

Another point to consider: If Pat absolutely BLASTED Dr. Chang's clinic, do you think he would get any number of invitations to visit other clinics?

Every clinic we get inside of helps us all, whether the doc is good or not so good.

When Pat does not offer an invitation to the Coalition, he is saying all there is to say.

I hope this helps you out M

I am sure Pat will correct me, clear this up as well.

[Pat - Community Publisher]

I appreciate input from members of this community in evaluating all potential physicians and clinics for recommendation on the Hair Transplant Network and or membership in the Coalition. So thank you for the above comments and feedback.

 

Dr. Chang's use of "modified follicular unit grafts" (multiple follicular unit grafts) in combination with micros (one hair grafts) and follicular unit grafts is philosophically different from pure follicular unit grafting in which only one, two, three and four hair follicular unit grafts are used exclusively. I believe Dr. Chang takes this approach because he believes it is in the patient's best interest in terms of achieving both naturalness and the illusion of fullness.

 

I do know that some very respected surgeons such as Dr. Ron Shapiro do use a limited number of multiple follicular unit grafts in the central areas (for appropriate patients) to create an optimal illusion of density that is still very natural looking. However, it appears that Dr. Chang uses a larger number of such multiple follicular units in his typical session than Dr. Shapiro and other physicians who are recommended on our community.

 

For example the donor strip Dr. Chang removed was 32 cm long by 1 cm wide. The average patient has about 90 follicular units per cm2. Thus 32 cm2 of donor tissue should yield about 2,880 follicular unit grafts. Dr. Chang's staff created about 1,500 grafts. This is largely due to them creating many grafts that contain multiple follicular units.

 

I don't think the patient I saw presented an ideal scenario for such a multiple follicular unit graft case since he was so extensively bald. I think that for such a scenario that a larger number of smaller follicular unit grafts would look more natural in creating a thin but natural look for such an extremely bald patient.

 

However, based upon looking at Dr. Chang's patient photos, I think that many of his patients do achieve impressive results in terms of naturalness and fullness from his combination grafting approach (see his photo gallery at http://www.hairtransplant.com/gallery.htm).

 

I would appreciate members of this community viewing his patient photos and giving me their opinions. Also do members of this community think that Dr. Chang's approach offers patients a viable alternative to pure follicular unit grafting for creating naturalness and density. If so, do members feel Dr. Chang should or should not be recommended on the Hair Transplant Network?

 

I think such an open discussion by forum members about our openness to alternative techniques and our standards for recommendation is healthy. Together we have a great deal of experience so collectively we can make better choices. I look forward to hearing your input and vote.

 

Pat

[Gorpy]

After studying some of Dr. Chang's results, I have my doubts. While some of his results look quite good, others are not up to par. Here is an example (case 6 under hairline restorations): hairline pic.

 

This hairline was totally recreated and in my opinion is unacceptable. It is pluggy, straight and unnatural. Some of his other hairline results look good. What this tells me is that the consistency is not there yet with Dr. Chang.

 

I think there might be some value in the double or combined FU's, but only in small numbers, specific hair types and very specific locations on the scalp.

 

I therefore would have to say no on the recommendation.

[M&M]

Pat,

 

Kudos to you for maintaining such open dialogue!

 

Gorpy,

 

I tend to agree with your comment on that hairline (along with several others). I went through the entire site and found a few issues:

 

- most photos are quite outdated where 2-3 surgeries were performed at no more than about 1,000 each. It seems that a 'big' case is 1500 grafts.

 

- naturalness. I'm not sure the end results are overly impressive with respect to coverage, density or appearing natural.

 

Consider the following:

 

Thin Hair

 

Straight Hairline

 

Hairline

 

That's not to say that there are not some impressive photos, but to Gorpy's point - it's about consistency.

 

Many photos are also very outdated (ie. 1996 or 1997). Hopefully, better examples are out there.

 

Finally, based upon the incision sizes, some outdated techniques (micro grafts) and overall result of the patient shown on Pat's visit, I would not support Dr. Chang being added as a recommended doctor especially when so many others perform exceptional, consistent, natural results.

 

(Note - edited as I accidentally hit 'post now')

[Bill - Seemiller]

Hello Pat,

 

Thanks for opening up this discussion. I would agree with my collegues above. I do have serious doubts that too many combined or double follicular units would create a natural look considering that hair follicles don't grow naturally that way. I admit it could have some use in small quantities in the middle to crown area...but I think too many could create a "pluggy" look, especially in the hairline.

 

Furthermore...I do have a slight problem with evaluating photos on a doctor's website and using that as reason to admit or dismiss him...simply because even if you go to Bosley's site, you can see some impressive looking before/after pictures, but in real life, the majority of the results have been disappointing to be generous. As an example, I've noticed that the lighting in many of the pictures is different in the before/after pictures. Not surpisingly, the lighting is brighter in the before pics exposing more flaws and darker in the after pics which creates more of an illusion of density.

 

So those are just my two cents.

 

Bill

[Pat - Community Publisher]

I really appreciate the above forum members time and well thought out reasoning, which I agree with. Collectively the elder members of this forum have a great deal of veteran hair restoration experience and I would like to invite them to review and vote on all future physicians who are considered for recommendation on this site.

 

Together I know we can we can do an optimal job of helping new potential patients find and learn about the very best hair transplant surgeons. In addition, if a physician who is recommended on this site does not perform as expected then they will be removed. I have gotten feedback from members of this forum that has resulted in the removal of several physicians over the past few years.

 

I want to assure that our community is the most reputable place in the world to find information and feedback about the best surgeons and hair transplant techniques available.

 

Onwards and Upwards, Pat

[hairbank]

Pat,

 

Thanks for posting the information on Dr. Chang. In viewing his site and information, I thought some of the before/after pics were pretty good...........some not so good. For the bad pics, it was tough for me to determine if they were bad because of a "pluggy look", low density or something else?

 

I did look at the link posted to the surgery and the one thing that did stand out was the incisions which looked very long/large. This HT was similar to the first I experienced with number of grafts and placement. Some of the incisions I received are a little noticable if you're very close up (I'm talking about 6" from my hairline or closer).

 

I really don't think any surgeon who creates incisions such as this should be recommended here. The end result can be awful for the HT patient, especially in the hairline.

[Bill - Seemiller]

I would like to invite them to review and vote on all future physicians who are considered for recommendation on this site.

 

I would be honored to give my input! Thanks for the opportunity Pat!

 

Bill

[Dr. Chang]

NHT's goal is patients' satisfaction. We strive ourselves to deliver the most fullness and natural looking with minimum donor hairs damaged or removed. If we can deliver the same satisfactory result, we will use less number of grafts to save patients thousands of dollars.

 

We had a patient who had similar baldness and same donor size (1.1 cm by 29 cm = 31.9 cm2) used as the patient in the surgical procedures that Pat observed. The patient had a hair transplant surgery on December 1, 2005; the total graft number was 1581G, which included 300 single follicular units and 1281 modified follicular units.

 

The modified follicular units basically are bi-follicular units but we try limiting the number of hair up to four hairs only. Hair line use single follicular units only. But single follicular unit contains 1-4 hairs to make sure the first line only transplant one hair unit, we call it micro graft. The mixed follicular grafting provides the most natural and fullness looking with minimum damaged or removed donor hairs at a reasonable price.

 

This patient promised that he would share his experience with us in a few days.

 

Why not listen to what he says?

 

Steven C. Chang, M.D.

[Pat - Community Publisher]

Dr. Chang,

 

Thanks for taking the time to post some clarification about your surgical philosophy. I know that you genuinely believe that your current multiple follicular unit graft technique provides your patients with the best value.

 

However, as you can see from the above posts, the majority of patients on this community have a strong preference for large numbers of smaller grafts placed into tiny incisions - even though such an approach may cost more per hair/follicle transplanted.

 

At its highest level of refinement, this procedure is referred to as "Ultra Refined Follicular Unit Hair Transplantation". All members of the Coalition of Independent Hair Restoration Physicians are required to perform this procedure with proven results before they are granted membership. Some of these members do also use a limited number of multiple follicular unit grafts that do contain 4 to 5 hairs. These grafts are still trimmed to make them as small as possible.

 

Recently Dr. Shapiro showed me one of the multiple follicular unit grafts that his staff had trimmed for use in my midscalp area. It appeared to be approximately the same size as a regular 4 hair follicular unit. In fact it was so refined that it was placed into a minimally invasive 1.2 mm incision.

 

I believe that you have the staff and skills that would enable you in time to also perform large sessions of small grafts placed into tiny incisions. I encourage you to consider moving toward doing larger numbers of smaller grafts, while using a smaller number of multiple FU grafts. I think patients online, especially on this community, would be more receptive to such a surgical approach.

 

I ask that members of this community discuss and debate the technical pros and cons of various techniques and procedures in this thread and not make harsh personal statements.

 

Dr. Chang and his staff extended every courtesy to me when I visited their office. I would like our community to do the same for Dr. Chang.

 

All the best, Pat

[Bill - Seemiller]

Dr. Chang,

 

Thank you for contributing to this forum and sharing your philosophy with us.

 

I am certainly not a doctor, but have been around here long enough, done enough research to read all about the pros and cons to many approaches, so allow me to ask you a few questions. I apologize if some of them are the same question reworded...so if you get to a question that you feel you already answered, feel free to skip the question.

 

1. What is the smallest modified follicular unit you make? I know you said the high end limit is 4 graft hairs, what is the low end limit?

 

2. What do you feel is the advantage of a modified follicular unit graft over a follicular unit graft? I have great concern that the majority of your grafts are modified whereas other doctors MIGHT use DFUs (Double follicular unit grafts) but only in rare cases and will keep them minimal, strategically and carefully planning where to place them.

 

3. Since hairs grow naturally in 1s, 2s, 3s, and 4s, what would the point be of combining these grafts?

 

4. From what I can tell in the limited sample I have to work with, you seem to space these MFUs (modified follicular units) relatively far apart. How would you compare this with dense packing? To me, it seems better to use naturally occuring FUs and place them closer together for a more natural and full look. Having grafts placed far apart while modified could appear clumpy or pluggy.

 

My main concern with this approach is plugginess, however, unlike my discussion with another doctor over DFUs, I don't think I'd be convinced that this philosophy will yield the best results. From the looks of the grafts placed in the photos that Pat posted, all the grafts seem pretty far apart, especially for someone who has lost a lot of hair. If you combine the far spacing issue with the majority of your grafts being modified, this seems to me a recipe for a pluggy look that can ONLY be masked if the patient has enough native hair to cover it...which to me, defeats the purpose of a hair transplant....especially if the patient loses more native hair.

 

I echo Pat's response above...to me, the best approach is being able to densely pack naturally growing follicular unit grafts, a few double follicular unit grafts when appropriate, and sub-follicular unit grafting where appropriate (making grafts smaller, not bigger).

 

But I'm willing to keep an open mind if you can convince me that your approach can yield consistent and positive natural results.

 

Bill

[the B spot]

Thank You Dr. Chang, and welcome.

 

I would like to say that pricing is only one variable to achieving a patients goals, but not the most important one. We feel that a very happy meduim has been struck by the leading physicians in the world doing Ultra Follicular Unit Transplantation, by charging a fee of 4.00 to 4.75 per graft up to 2000 then 2.00 to 2.50 a graft thereafter. In addition, MANY clinics work with patients often throwing in "extra's" for free, or working with budgets.

 

During Pat's visit a patient had a large strip of donor tissue removed, yielding about half of what it should in individual grafts.

 

My biggest concern is why you have resisted embracing the latest techniques and technology?

 

1. incision size--- it is obvious that you use what is considered larger instrumentation (1.5 to 2 mm) (guess) in order to fit such large grafts into recipient sites. This leads to cobblestoning, pitting, irregular angle, reduced naturalness, etc...

 

2. Large amounts of tissue still connected to the "trimmed" grafts. It is my understanding that excessive tissue surrounding grafts can die off creating complications. In addition, this excessive tissue demands larger incisions.

 

3. Slitting method-- there are some that favor acute saggittals, laterals, etc.. but your slitting methods are uniform, focused solely on spacing and density only. I would think you would find it hard to control graft angle and orientation, in the never ending search to mimick nature.

 

I respect anyone willing to put themselves into the fray for public scrutiny, it seems to make us better. However, I would recommend that you embrace the technology of higher magnification in order to be able to see sections of the scalp and literally make .6 or .7 incisions and transplant at 45 to 60 fu's cm/2.

 

I would also recommend you require your staff to further trim grafts and produce higher graft counts, because your 1500 grafts contain the same hairs as a 2800 ultra refined graft session, so they are the same, with the exception of technique and result.

 

It is all about striving to give the "informed" patient what they want, which is highly labor intensive, more cost prohibitive session, but ultimately producing better results and VERY happy patients.

 

Thanks Again Dr. Chang.

[Dr. Chang]

Thank you for giving me an opportunity to express my point of view. I will reply all the questions and concerns systematically within a few days.

 

The gentleman who had similar baldness and same donor size used as the patient in the surgical procedures that Pat observed already sent me his letter. I have uploaded his letter, before and 6 months after surgery photos to my website at: my patient's letter and photos

 

Total coverage area is 93cm2. The donor size is 31.9 cm2 (contain almost 3200 F.U.) 1581 grafts. Density is 34%. Total surgery fee is $7005.

 

 

Best Regards,

 

Steven C. Chang, M.D.

[NervousNelly]

I really struggled with whether or not to comment because I truly appreciate the fact that Dr. Chang is spending his time to contribute to this forum. If the testimonial is legit than I have to say that the patient is happy with his results and I'm glad for him. Ultimately that is the primary concern. I guess that there are several different standards that we all have in mind and I personally expect better. I guess it is great to not always see the poster boys because we then have unrealistic expectations, however as Bill pointed out earlier, there are some concerns about the somewhat outdated technology.

[Dr. Chang]

If ultra thin graft and dense packing are the best techniques; I already use it for more than 10 years.

 

For the past 10 years, I have performed hundreds of eyebrow transplantation. The ultra fine graft is exactly the size been used.

3 ultra thin graft photos took back in 2001 and 2002

 

(The grafts come with longer hair because they are used for eyebrow transplantation. With longer hair, patients can see immediate result and it also enables us to check the hair direction easily.)

 

I would like to present a typical eyebrow transplant that I did yesterday (December 7, 2006.) The patient is an Asian male. Each brow is about 5 cm in length, average width is 0.6 cm, and the area is 3 cm2. The total area for both eyebrows is approximately 6 cm2. We transplanted 555 grafts. This is about 92 grafts per cm2. I will post a series of zoom-in photos next week.

 

Our surgical team has the ability to perform ultra thin graft and extremely dense packing, but I only limit it to certain area.

 

Steven C. Chang, M.D.

[Bill - Seemiller]

Dr. Chang.

 

No offense intended, but your last post didn't address any of the concerns that Pat, myself, or B-spot have posted. I don't want to disrespect you because I value your input on this forum as I know others do as well...I think it's a great learning experience for everyone...but allow me to point out a few things that are troubling me:

 

If ultra thin graft and dense packing are the best techniques; I already use it for more than 10 years.

 

Your above quote "appears" contradictory to the below quote:

 

...The patient had a hair transplant surgery on December 1, 2005; the total graft number was 1581G, which included 300 single follicular units and 1281 modified follicular units.

 

What do you refer to as an "ultra thin graft"? Being that the majority of your grafts are modified into larger groups of hairs, what exactly is thin about it? Regarding dense packing, can you show us some photos of before/right after surgery/and after pictures of dense packing? For someone to day they've been dense packing for 10 years, when dense packing has changed dramatically even over the last 5 years doesn't give me much comfort. If you are willing to share with us, how have you changed your techniques from 10 years ago to today? That might address more of the concerns. What do you consider dense packing? What is the closest that you can put your grafts together in a single session...how many grafts per cm/2 can you yield in a single session assuming a patient warrants this type of dense packing?

 

Additionally, when you say "The ultra fine graft is exactly the SIZE been used" what size are you referring to? Are you talking about the incision size? Are you talking about dense packing?

 

I don't mean disrespect by my questions, but I still feel my flags are raised and I don't feel that you have attempted to explain or answer any of these questions.

 

Sincerely,

 

Bill

[Bill - Seemiller]

Thought I'd bump this post. Any other thoughts are welcome...feel free to tell me if I'm wrong, but there are still some "red flags" that are up for me that I feel should be addressed.

 

Bill

[the B spot]

Hey Bill, yes you are right to have some red flags, buddy!!!!

 

I really think Dr. Chang is surprised at how we view his current techniques. I also think he really wants to join our community.

 

Once I saw the tiny eyebrow incisions, I thought, "Wow, this guy can do Ultra R. F. U. G., but is simply not choosing to do so!"

 

I sent Dr. Chang a PM about some perspectives that I have and how a difference exists between non-educated vs. educated patients. In addition, I suggested a couple of changes that might help him out.

 

I normally would not be so presumptious, (yeah right!), but I felt Dr. Chang is really feeling his way out here, so why not?

 

Again, it is a good idea to keep a close watch and steer people to the right Doc's, but I hope Dr. Chang ends up being one of them.

 

Time will tell....

 

Cheers Buddy!!!

[NervousNelly]

Bill,

You are not wrong at all. You are just looking for clarification of his techniques. Yes, a doc may be able to dense pack an eyebrow but why is he using such large numbers of modified Fu on the scalp? Many of the patient photos on his site are not spectacular in my opinion.