Why some recommended doctors are not included in the Coalition.

[Pat - Community Publisher]

I think some visitors to our community have been a bit confused as to why some physicians who are recommended on the Hair Transplant Network are not members of the Coalition.

 

I would like to clarify the distinction between a physician only recommended on the Hair Transplant Network and that of a physician who is both recommended on the Hair Transplant Network and also a member of the Coalition of Independent Hair Restoration Physicians.

 

This distinction is written on the page entitled "How we select the physicians recommended on this site". But I think that many have not seen this page. In any case, a fuller explanation, with background may be even better.

 

The Hair Transplant Network has existed now for over six years. When it began "Follicular Unit Hair Transplantation" was the new "gold standard" and this community led the way in helping people learn about it and the few physicians who at that time performed it. As patients demanded this more patient friendly procedure more and more physicians moved away from mini/micro grafting and embraced the new gold standard procedure. Those who did this procedure successfully were recommended on this site.

 

Six years ago a "mega session" was 1,500 grafts and sessions bigger than 2,000 grafts were rare. Surgeons also typically used blades to create incisions that were 1.5 mm (versus incisions as small as 0.6 or 0.7 that are now created with Ultra Refined Follicular Unit grafting). With such big incisions and bulky follicular unit grafts, dense packing was not really possible. Thus to achieve decent cosmetic density patients needed to do two or more sessions in a given area.

 

Six years ago standard follicular unit grafting was more refined than the mini/micro graft procedures that preceded it. But over the past several years leading physicians have continued to improve and refine the follicular unit procedure.

 

Two or three years ago it became apparent that some physicians performing follicular unit grafting had pulled away from the pack and had taken follicular unit grafting to an ultra refined level. These physicians were using very tiny blades and needles to create much smaller and less invasive incisions ??“ into which were placed grafts that were more slender (with all epidermis surrounding the hair shaft and the excess fat tissue removed). This more minimally invasive and refined procedure enabled surgeons to dense pack follicles in higher densities so that patients could achieve acceptable cosmetic densities in "one pass".

 

These ultra refined techniques also had less impact on the scalp and thus "shock fallout" diminished for patients. Healing time was also faster.

 

Some surgeons also moved toward performing larger sessions exceeding 3,000, 4,000 and some times even 5,000 grafts in one session. Such large sessions required the clinic to have large staffs that worked longer hours. But such super mega sessions of ultra refined grafting enabled patients to get optimal naturalness, density and coverage in one session.

 

Naturally patients began to identify and gravitate to those physicians and clinics that provided this more evolved procedure that was ideal for the patient, even though tougher on the clinic.

 

I felt it was important to identify and recognize those physicians and clinics who had risen to the challenge of successfully performing what we now refer to as Ultra Refined Follicular Unit Hair Transplantation. So in March of 2005 the membership standards for the Coalition of Independent Hair Restoration Physicians were raised to an ultra high level and only physicians who had mastered this most advanced and refined technique were allowed to renew their memberships. Six members did not meet this much more demanding standard and were dropped from the Coalition.

 

Thus only those who had evolved their skills, staff and techniques high enough to perform large sessions of ultra refined grafting were invited to remain in the Coalition. The elite members of the Coalition are recommended on the Hair Transplant Network and exclusively presented on the Coalition Hair Loss Learning Center.

 

Those physicians who continue to provide good solid standard follicular unit grafting with successful results are still recommended on the Hair Transplant Network for follicular unit grafting. But they are not granted membership in the Coalition. Thus if a patient, for example, only needs or wants a 1,500 session and wants to stay in their area they can still find a competent and skilled physician who performs standard follicular units.

 

Since there are over 1,000 physicians providing hair transplantation in North America alone, those recommended on the Hair Transplant Network but who are not in the Coalition are still providing much better results than the average clinic that often provides hair transplantation as a sideline.

 

However, for those patients who need or desire much more coverage and density in one session, they should consider traveling to a clinic with a proven reputation for providing large sessions of ultra refined grafting.

 

Members of the Coalition now are truly masters of ultra follicular unit hair transplantation. There are over 600 members of the ISHRS (International Society of Hair Restoration Surgery). But there are currently only 23 members of the Coalition.

 

In my opinion, very few ethical physicians are successfully performing large sessions of ultra refined follicular units with consistently excellent results. Over the past nine years I have attended over a dozen international hair restoration meetings, researched hundreds of physicians and clinics, and traveled to observe surgeries in dozens of clinics from Sao Paulo, Dublin, Vancouver and in between and the number of truly excellent clinics is disappointingly small.

 

Hair loss sufferers come to this community to learn about, discuss and find the very best clinics. The Coalition and its membership is the culmination of my last nine years of research in seeking the very best. I intend to keep the standards for Coalition membership ultra high. In fact only one new member has been added in the past six months, despite interest from dozens of physicians.

 

I expect that the Coalition will not only provide patients but the hair restoration profession with a true benchmark for quality. Those who do the hard work required to be granted membership and who are willing to have their results critiqued on our forum will earn our trust.

 

 

I recently posted an article on our blog that was written by Coalition member, Dr. Tykocinski of Brazil, in which he challenges his colleagues to adopt the new "gold standard" in their clinics. Physicians are now feeling the pressure to meet the new gold standard not only from educated patients but from Coalition physicians.

 

Many will make excuses and drag their feet. But a few will rise to the challenge and they will in time be invited to join the Coalition. I hope and expect that by demanding the very best from physicians we will provide a strong incentive for hair restoration physicians to embrace and provide only the very best techniques.

 

Onward and Upward, Pat

[Pat - Community Publisher]

I think some visitors to our community have been a bit confused as to why some physicians who are recommended on the Hair Transplant Network are not members of the Coalition.

 

I would like to clarify the distinction between a physician only recommended on the Hair Transplant Network and that of a physician who is both recommended on the Hair Transplant Network and also a member of the Coalition of Independent Hair Restoration Physicians.

 

This distinction is written on the page entitled "How we select the physicians recommended on this site". But I think that many have not seen this page. In any case, a fuller explanation, with background may be even better.

 

The Hair Transplant Network has existed now for over six years. When it began "Follicular Unit Hair Transplantation" was the new "gold standard" and this community led the way in helping people learn about it and the few physicians who at that time performed it. As patients demanded this more patient friendly procedure more and more physicians moved away from mini/micro grafting and embraced the new gold standard procedure. Those who did this procedure successfully were recommended on this site.

 

Six years ago a "mega session" was 1,500 grafts and sessions bigger than 2,000 grafts were rare. Surgeons also typically used blades to create incisions that were 1.5 mm (versus incisions as small as 0.6 or 0.7 that are now created with Ultra Refined Follicular Unit grafting). With such big incisions and bulky follicular unit grafts, dense packing was not really possible. Thus to achieve decent cosmetic density patients needed to do two or more sessions in a given area.

 

Six years ago standard follicular unit grafting was more refined than the mini/micro graft procedures that preceded it. But over the past several years leading physicians have continued to improve and refine the follicular unit procedure.

 

Two or three years ago it became apparent that some physicians performing follicular unit grafting had pulled away from the pack and had taken follicular unit grafting to an ultra refined level. These physicians were using very tiny blades and needles to create much smaller and less invasive incisions ??“ into which were placed grafts that were more slender (with all epidermis surrounding the hair shaft and the excess fat tissue removed). This more minimally invasive and refined procedure enabled surgeons to dense pack follicles in higher densities so that patients could achieve acceptable cosmetic densities in "one pass".

 

These ultra refined techniques also had less impact on the scalp and thus "shock fallout" diminished for patients. Healing time was also faster.

 

Some surgeons also moved toward performing larger sessions exceeding 3,000, 4,000 and some times even 5,000 grafts in one session. Such large sessions required the clinic to have large staffs that worked longer hours. But such super mega sessions of ultra refined grafting enabled patients to get optimal naturalness, density and coverage in one session.

 

Naturally patients began to identify and gravitate to those physicians and clinics that provided this more evolved procedure that was ideal for the patient, even though tougher on the clinic.

 

I felt it was important to identify and recognize those physicians and clinics who had risen to the challenge of successfully performing what we now refer to as Ultra Refined Follicular Unit Hair Transplantation. So in March of 2005 the membership standards for the Coalition of Independent Hair Restoration Physicians were raised to an ultra high level and only physicians who had mastered this most advanced and refined technique were allowed to renew their memberships. Six members did not meet this much more demanding standard and were dropped from the Coalition.

 

Thus only those who had evolved their skills, staff and techniques high enough to perform large sessions of ultra refined grafting were invited to remain in the Coalition. The elite members of the Coalition are recommended on the Hair Transplant Network and exclusively presented on the Coalition Hair Loss Learning Center.

 

Those physicians who continue to provide good solid standard follicular unit grafting with successful results are still recommended on the Hair Transplant Network for follicular unit grafting. But they are not granted membership in the Coalition. Thus if a patient, for example, only needs or wants a 1,500 session and wants to stay in their area they can still find a competent and skilled physician who performs standard follicular units.

 

Since there are over 1,000 physicians providing hair transplantation in North America alone, those recommended on the Hair Transplant Network but who are not in the Coalition are still providing much better results than the average clinic that often provides hair transplantation as a sideline.

 

However, for those patients who need or desire much more coverage and density in one session, they should consider traveling to a clinic with a proven reputation for providing large sessions of ultra refined grafting.

 

Members of the Coalition now are truly masters of ultra follicular unit hair transplantation. There are over 600 members of the ISHRS (International Society of Hair Restoration Surgery). But there are currently only 23 members of the Coalition.

 

In my opinion, very few ethical physicians are successfully performing large sessions of ultra refined follicular units with consistently excellent results. Over the past nine years I have attended over a dozen international hair restoration meetings, researched hundreds of physicians and clinics, and traveled to observe surgeries in dozens of clinics from Sao Paulo, Dublin, Vancouver and in between and the number of truly excellent clinics is disappointingly small.

 

Hair loss sufferers come to this community to learn about, discuss and find the very best clinics. The Coalition and its membership is the culmination of my last nine years of research in seeking the very best. I intend to keep the standards for Coalition membership ultra high. In fact only one new member has been added in the past six months, despite interest from dozens of physicians.

 

I expect that the Coalition will not only provide patients but the hair restoration profession with a true benchmark for quality. Those who do the hard work required to be granted membership and who are willing to have their results critiqued on our forum will earn our trust.

 

 

I recently posted an article on our blog that was written by Coalition member, Dr. Tykocinski of Brazil, in which he challenges his colleagues to adopt the new "gold standard" in their clinics. Physicians are now feeling the pressure to meet the new gold standard not only from educated patients but from Coalition physicians.

 

Many will make excuses and drag their feet. But a few will rise to the challenge and they will in time be invited to join the Coalition. I hope and expect that by demanding the very best from physicians we will provide a strong incentive for hair restoration physicians to embrace and provide only the very best techniques.

 

Onward and Upward, Pat

[Bushy]

Pat: Several years ago I expressed concern that paid memberships by doctors would corrupt your objectivity in recommending them. However, your actions have made it crystal clear that doctors must earn recommendation on this site or membership in the Coalition. You have not hesitated to refuse membership to those whose skills or ethics are lacking, regardless of the fees they are willing to pay. In fact, you have canceled memberships of those who have failed the test, basically turning away $$$ in favor of maintaining a high degree of competence, thus solidifying the Coalition's credibility.

 

It must be hard for you to walk that fine line between good business and solid ethics -- isn't it a challenge for us all! However, you have proven time and again that you will not let undeserving doctors into the Coalition, or recommend them on this site. In addition, you have personally visited many clinics, observed surgeries, and openly documented them. Consequently, your site and your Coalition have, in my mind, more credibility than any other. Thanks for doing your best to move the field of hair transplantation "onward and upward."

[Gorpy]

[Guest Landen]

Ironically, my account on another forum was just suspended, not for offending anyone, or saying anything inappropriate, but for "criticizing another doctor other than Dr. Hasson

 

 

That isn't the reason that you got banned and you know it.

 

Now tell the truth, the whole truth, and nothing but the truth.......

[Pat - Community Publisher]

Bushy,

 

Thanks for noticing. I've made my share of mistakes. But I'd like to believe that I'm on the right course and that the long time regulars online like you have come to see that my actions match my statements.

 

As for discussion forums they are like parachutes - they only work when open. On this forum we have to let the chips fall where they may and deal in reality ??“ the good the bad and the ugly.

 

This forum has so many informed and considerate members that it now virtually moderates itself. The few clinics and their agents who have been notorious for covert self promotion typically know that their messages will back fire on this forum and so they stay away.

 

We are all held accountable for our actions on this forum, not just the physicians. It's this accountability and transparency that give this community authenticity.

 

Thanks for everyone's generous participation on this forum. You make this site into a community.

 

Onward and Upward, Pat

[spoon]

Originally posted by Pat:

Six years ago a "mega session" was 1,500 grafts and sessions bigger than 2,000 grafts were rare. Surgeons also typically used blades to create incisions that were 1.5 mm (versus incisions as small as 0.6 or 0.7 that are now created with Ultra Refined Follicular Unit grafting). With such big incisions and bulky follicular unit grafts, dense packing was not really possible.

 

Whenever I read a comment like this I feel compelled to point out that Seager was doing 3,000+ one-pass sessions as far back as 1998. I hope that doesn't come across as too much cheerleading but I'm very grateful to him for his excellent work on me.

[Mark H]

Thanks for the explanation Pat, but this blows my mind.

 

Is there really a reason to go to someone who isn't performing the highest standard of work? How can someone NOT employing the highest standards be "recommended"?

 

For example, I need a heart transplant, and I go to Pat the Heart Forum Guy, and he says, Doctor Fixit is recommended. He's not up on the latest techniques, either because he doesn't choose to be, or he's not interested, or perhaps he's not aware of them, but he appears to be solidly up on the techniques of several years ago, so good luck to you.

 

How on earth can someone using second rate techniques be recommended? For me, that redefines recommended into something it isn't. I can certainly understand not dissing such a doctor, but recommending them?

 

mark h

 

mark h

[spoon]

You have not hesitated to refuse membership to those whose skills or ethics are lacking, regardless of the fees they are willing to pay. In fact, you have canceled memberships of those who have failed the test, basically turning away $$$ in favor of maintaining a high degree of competence, thus solidifying the Coalition's credibility.

Hang on, now I have some questions about these statements. Does this mean that coalition docs pay extra fees to be recommended as coalition members? Do "recommended" non-coalition docs pay fees? Same fees or different fees? If so does it also mean that a doc could have their coalition status removed if they don't pay that fee? If it's a policy then I wouldn't personally disagree with it because that's just how things are but I think it would be nice to know.

Consequently, your site and your Coalition have, in my mind, more credibility than any other.

Would you have made this statement when H&W were not recommended? As I remember they were highly recommended on this board for a while, then not recommended, then recommended again, but the surgeries didn't change during that time.

[Pat - Community Publisher]

Spoon,

 

Only physicians who meet the standards and criteria stated on this site are presented. This has long been stated on our sites.

 

"How this online community is funded.

 

Those surgeons who are carefully reviewed and chosen for recommendation on this site contribute a monthly fee to co-sponsor this online community and display their before and after photos and contact information"

 

Physicians who support this community understand that this community has numerous expenses, including a full time programmer/web master, a part time graphics person, a video editor, an advertising budget for over 140 pay per click ads, travel expenses etc etc.

 

The physicians who have been invited to be presented on our community have not taken issue with contributing to support this community. They realize that the value of being a sponsor far exceeds their contribution. No physician has ever been take off this site due to finances. What has determined who is presented has been merit and quality.

 

As for Hasson and Wong, our since resolved differences had nothing to do with fees. Those who were active on this forum during this time know this.

 

Mark H,

 

As I mentioned there are over 1,000 physicians offering hair transplant surgery in North America alone. The Hair Transplant Network provides recommendations/suggestions for physicians who have a proven track record of providing quality follicular unit grafting. Some of these clinics have the additional capability to provide larger and denser results in one session. These clinics are eligible for membership in the Coalition.

 

Does not having the capability to do very large sessions of smaller grafts make a clinic unethical and sub pare in your opinion? I think that for those who want a recommendation for a solid and ethical choice in their area, versus choosing a clinic from TV or the phone book, the non Coalition members still provide a viable option.

 

Ultimately the patient needs to choose whether they want to travel to achieve their end results in less time and sessions. They have many great options to choose from on our community.

 

All the best, Pat

[Mark H]

Does not having the capability to do very large sessions of smaller grafts make a clinic unethical and sub pare in your opinion?

 

 

Hey Pat,

 

I don't know why you brought up the issue of ethics, because I never did. My discussion has to do with quality as it relates to this site's recommendations.

 

Now you know 100 times more about this stuff than I do, so I only have what you're telling me to go on.

 

Your last message said as quoted above that a recommended doctor simply doesn't have the capability to do very large sessions of small grafts.

 

However, your first message says that you define ultra refined techniques as not only allowing larger sessions, but also less shockloss, faster healing time, higher densities, less invasive incisions.

 

So, why would a doctor, performing procedures that are not state of the art, and that do not offer the above be recommended?

 

Which patient does not deserve faster healing times, less shock loss, etc?

 

Are standard graft techniques on a par with Ultra Refined or aren't they?

 

mark h

[the B spot]

Mark--- I think we a patients and posters have to decide what level of expertise we desire. The real truth of the matter is that only a few doc's truly provide ultra-refined sessions. I guess some people just feel like they do not have to go to these doctors, instead choosing a dr close by, or is lower priced, etc...

I know you can't figure out why somone would chose to go to a doctor that is not a Coalition doc, but these recommended Doc's represent SOLID and SAFE alternatives to Bosley, MHR, and other unscrupulous clinics. I like to think of this as buying the best car possible or buying a Chevy. The Chevy is solid and dependable, but is not going to offer you the performance of a BMW or Mercedes.

I see the major difference between the recommended list and the Coalition Docs as session size, density per session, and excess tissue surrounding grafts. While there is nothing ethically wrong with these doc's, it is ok to place them at level lower than the Coalition docs, IMO. I would not go to one of these docs after viewing the work of other clinics, but that is just me.

I view the recommended docs as a viable alternative to chains or just plain shitty docs, and a person can at least get some feedback on the work they perform here. Solid work, solid review. Bad work, bad review.

In the end it comes down to patient research and education and the desire to approach being bald with a Chevy or a Mercedes

Again just my opinion...

[Mark H]

If this were Priceline.com and we were discussing a rental car, or a hotel, I'd agree, but this is a medical procedure.

 

Furthermore, I've never seen...maybe its happened...someone on this forum suggest a doctor who is not doing the best work merely because of cost or location, quite the contrary.

 

What happens if someone sees a doctor is recommended without reading the fine print on this site and later discovers their work isn't what it ought to be, eh?

 

mark h

[the B spot]

Mark, I have seen quite a few people choose a Dr. simply based on the location or price of session. I think a poster named Lon decided to go to a clinic just for this reason. I think he may have even suggested he would be ok with micro and minis for 2.00 a graft. I would hope that he is in the minority, but how many people simply scan the site, find the first clinic and set an appointment? I think the purpose of that is these recommended doc's represent the "best case" for these types of people. They do "good" work on guys that need 1000, 1500 grafts, but thats it. Good hairlines, decent density, thats about it, nothing special. A MARKED difference exists between the recommended docs and the Coalition docs.

I can't imagine not doing a fair amount of research before doing this, but other people simply do not feel the same way. Otherwise, Bosley and MHR would be bankrupt, along with quite a few other unethical hacks.

[Mark H]

B Spot, if someone chooses a doctor based on geography or price, even when they understand the doctor's technique may be dated, then good on them.

 

I am suggesting that when this site says that a doctor who is recommended is doing "state of the art" (this is in the definition), and then they apparently aren't, or at least may not be, that could lead to a phone call from the law firm of Dewey, Cheatam, and Howe.

 

That said, if no one else cares, then Caveat Emptor applies.

[Bushy]

Originally posted by Mark H:

For example, I need a heart transplant, and I go to Pat the Heart Forum Guy, and he says, Doctor Fixit is recommended. He's not up on the latest techniques, either because he doesn't choose to be, or he's not interested, or perhaps he's not aware of them, but he appears to be solidly up on the techniques of several years ago, so good luck to you.

 

How on earth can someone using second rate techniques be recommended? For me, that redefines recommended into something it isn't. I can certainly understand not dissing such a doctor, but recommending them?

Mark, perhaps a better analogy would be comparing Smith and Jones as caterers. Smith is small-town operation -- works out of his garage. He makes delicious food, and is the perfect caterer for your birthday party or Thanksgiving dinner. Jones makes equally good food, but has a 2,000 square foot commercial catering facility, a staff of 20, a state-of-the-art-kitchen and 3 trucks. He is the guy you want to cater your wedding.

 

Smith and Jones, one on one, are equal in their culinary skill; but one of them is a more elite "caterer." Jones has been granted membership in the County Culinary Coalition.

[Mark H]

Lets complete the analogy Bushy. I go to the Caterer Forum, and both are recommended as state of the art caterers.

 

I pick Smith. Oops. I've assumed that "recommended" and "state of the art" means he's as good as Jones. Too bad, my mistake. It is _my_ mistake, right?

 

mark h

[Bushy]

Originally posted by Mark H:

Lets complete the analogy Bushy. I go to the Caterer Forum, and both are recommended as state of the art caterers.

 

I pick Smith. Oops. I've assumed that "recommended" and "state of the art" means he's as good as Jones. Too bad, my mistake. It is _my_ mistake, right?

 

mark h

Mistake? NO, I heard your birthday party was spectacular!!!! Now if you needed to cater your 500-guest wedding, it would have been a mistake. Like I said, Smith is just as good as Jones, for certain situations.

[the B spot]

Thanks Bushy!!!!

Mark, good questions and responses as usual, my friend.

Glad to see this hasn't denegrated into something other than what it is.

Cheers!!!

[Bushy]

Originally posted by the B spot:

Thanks Bushy!!!!

Mark, good questions and responses as usual, my friend.

Glad to see this hasn't denegrated into something other than what it is.

Cheers!!!

Well, it's easy with guys like Mark, who are totally decent, intelligent, respectful individuals making a valid point with which I happen to disagree.