Patient of Joseph L. Williams, M.D. - 2030 grafts

[Advanced Medical Hair Inst]

27 year old male received 2030 grafts: 500 grafts in the hairline, 1030 grafts on the front/top and 500 grafts in the crown. These outstanding results are only 6 months post-op. We'll post 1 year follow up photos in June 2010.

Blade Size: 0.8mm for the hairline, 1.1mm for the front/top and 1.2mm for the crown.

[phil mascallpen]

I can't tell if there is any difference to the hairline because all you've shown are after pictures with the hair combed forward.

 

Perhaps you could post some pictures holding the hair up with a comb just like you did in the before photos.

[Bill - Seemiller]

AMH,

 

I agree with Phil that posting photos showing the hairline with the hair pulled back would give us a better idea of the success of the procedure. I encourage you to post additional photos showing the actual hairline if you have them. Otherwise, in the future, I do suggest taking better photos that show the actual transplanted area so we can better appreciate the quality of your work.

 

Best wishes,

 

Bill

[TC17]

Obviously we don't know what this patient's future may bring, but I find it slightly troubling that his crown was transplanted, considering he is only 27. Regardless of his (maybe positive) family history, his possible use of medication, and the few number of grafts going to the crown, I still believe that in the face of an unpredictable future, it was a mistake to place grafts there.

[hdude46]

not every 20 something yr old who is balding is headed for a nw6-7, in fact if u look at most peoples blogs on here i think u will see a lot of the same 'i started losing my hair in my late teens early 20's'. By your standards no one should have a ht unless they are 60 and nw2 w/ no chance of donor thinning. C'mon, I think the docs here, which are recommended for a reason, have ethics and know what they are doing.

 

aaron1234 got grafts in his crown and he is about the same age, from arguably the best clinic here IMO. troubling? maybe to you, but I doubt they would steer a patient wrong and not look out for his well being.

[thanatopsis_awry]

The key question, which seems to be unresolved, is whether the patient is on fin, and if so, for how long. If he isn't on it, yet is open to getting on it; or if he is on it, but it has been for too long, it would seem a bit unnecessary to me to graft into his crown.

 

Either way, it doesn't seem to me to be aclear, let alone major, misstep. Grafts were going to go there anyways, given the patient's apparent wishes, and to do so now in a mild way that doesn't place an excessive burden on the patient isn't any more reckless than simply getting a HT to begin with, and the invariable risk(s) that come into play. Seems applicable to Aaron's SMG HT, I agree, too.

[the B spot]

Transplanting the crown on patients in their 20's early 30's is not to be taken lightly.

 

The obvious supply and demand issues abound, but there is a mentality of what does the future hold?

 

We really do not like to target the crown on young patients...in this instance, approaching this particular patient, I would probably tell him that he should address his other areas, continue on Prop and employ concealers....plan on possibly doing a crown HT in the future if everything holds up. Please note, this is not a "right way", rather, just being cautious. I'm sure Dr. Williams assessed the patient and in his opinion, went forward properly.

 

In Aaron's case, he had prior work that we had to balance out, and only after assessing his donor, Dr. Paul determined that transplanting to the top of the crown would still allow for Aaron to lose the mid-scalp and still have enough to fill the "in-between" even should he go to a NW5-6. Aaron is also aware that he will likely need at least one more HT in the future.

 

With that said, it is not normal practice for us to transplant the crown on young patients, absent Dr. Ron/Dr. Paul assessing the patient and determining that a particular individual is a proper candidate for such an approach. Much patient education and explanation is done prior as well.

 

Take Care,

Jason

[TC17]

hdude46,

 

I really don't think you fully grasp the potential for problems down the road. You're right that not every person will become a NW 6 or 7, but there is NO way of knowing whether THIS particular patient will become one of them. Citing statistics or the balding patterns of others on this site is irrelevant. The only thing that matters is this patient, and neither we, nor the patient, nor Dr. Williams can gauge just how bald he will become. However, we do know that those who begin balding young tend to advance to a higher Norwood level more often than those who bald later. That doesn't mean that this particular patient will do so, but it does make it more likely than if he were 40.

 

As for your statement that I believe only 60 year old NW 2s should undergo a transplant, well, that's just absurd. I believe in the judicious use of grafts, smart planning, and not kowtowing to the whims of the patient.

 

I genuinely worry that prospective patients will see this result, and assume that crown transplantation in the young is both safe and the norm. In fact, you yourself said that you doubt a recommended physician would do something that could harm the patient, meaning that you trust the judgment of the physician. It's fine to trust the skill of the physician, but to trust his ability to predict the future accurately, well that's a different story.

[hdude46]

tc17, i think u are mistaken about my grasp about potential problems down the road...again. No one can predict the futre. The sooner you understand that, the sooner you will realize there is no way any dr can tell ANY patient what he will become no matter at what age. However, I'm willing to trust physicians such as Dr. Shapiro or Dr. Hasson ect. that know and have been involved in ht's much longer than you have to look after the younger patient b/c they have transplanted in young patients before, some much younger than me.

 

Again, hair characteristics, family history, use of meds, ect. play a large role, and yes, they can't count for everything, but at some point any patient under 40 getting a ht is taking a risk. I think everyone hears you loud and clear. A lot of your posts are 'what about the future', and thats good, but you have no idea anything about that patients family history, use of meds, hair characteristics ect. For someone like yourself who has a family full of nw5,6,7's, it makes sense to be very concerned, but not everyone is like this. My point is that every case is different and the physician and patient will make a surgical plan that fits and is best. Its very good to be concerned about the future, hell I am very much so, but at some point you will have to get in the chair if you want to fix your problem.

 

For you, that sounds like it will be sometime in your 40's, and thats fine and smart. For others, that time is younger b/c they can afford to based on their particular case where it might be less of a risk if that makes sense.

[Bill - Seemiller]

TC17,

 

Part of judging the quality of a physician is judging their ability to plan for the long term. While future hair loss isn't entirely predictable, a quality physician will plan and use grafts appropriately to try to meet both the immediate and long term needs of the patient, assuming they're realistic and in the patient's best interest.

 

This patient still has a great deal of natural hair. At this point, we don't know his family history of hair loss nor do we know a) if he's on any medical treatment, b) his available donor supply. I'm sure Dr. Williams performed a detailed analysis before performing surgery and is looking out for the patient. Hopefully he will share some of these details with us. I'm sure this is why he only placed 500 grafts in the crown and performed a relatively small session in the scheme of things.

 

Remember that good planning is about minimizing risks, not eliminating them.

 

Best wishes,

 

Bill

[latinlotus]

I also question touching the crown. The loss seems so minimal, it is barely noticeable. A bit of toppik could have done the job