Shaving the recipient area verses non-shaving the recipient area during surgery

[Bill - Seemiller]

Hello everyone,

 

I thought I'd move this topic here since it was being discussed in an unrelated thread. Please post all opinions and replies here:

 

What has been said so far:

 

Originally posted by Mrjb:

" Could that be partially due to shaving the area? I can't say for sure...but I would guess that incisions are easier to make when other recipient hair is not in the way, so I would venture a guess to say yes".

 

 

 

Good discussion

 

Easier does not translate to better. The point is; in my view, everyone has their opinion. Now, basing your argument on this i.e. " The best" is still an opinion.. If you say H & W is the best because he shaves the receip area that's implying all other doctors are not good by doing otherwise.. Also, Mega sessions i.e 5000-7000 graft HT's in my opinion are a bit dangerous.. With a limited donor area, what happens if 5 years down the road you have more loss and no more or little donor area.. You might end up with problems.. Guys, you can argue either way but personally, i prefer a more conservative approach. That's my opinion but I certainly respect each credible doctors preference and style ..

 

Originally posted by Bill:

MrJb,

 

I agree good discussion...and I agree with you. I hope I didn't portray my argument as stating that shaving area = the best. All I meant to state is Dr. Hasson makes a compelling argument as to why it's beneficial. I think it's better to make things easier on the doctor to minimize risk. I think most doctors would argue that shaving would make it easier for them, but many don't require it. I believe we are on the same page here...

 

Regarding a more liberal or conservative approach...I don't think there is really any argument to proove what's "best" or not...it's just a preference. I would argue that a 5000-7000 session isn't dangerous if done ethically and correctly. Though I would agree that it CAN be dangerous like in a case where a 20 year old want to densely pack 4000 FUs into the hairline to achieve max density when his hairloss is so unpredictable. But 7000 FU megasessions on a NW5 for example who is 35 years old seems like a better (better is not factual, only opinion) option to me than doing 2 or 3 smaller sessions.

 

But yes, I agree...even those who are more conservative as long as they are yielding and producing excellent results, it doesn't take away from their credibility. After all...the Proof is in the pudding right?

 

Bill

 

Originally posted by the B spot:

Shaving the recipient area is the BEST method for transplantation----- regardless of session size.

 

This is not to say that tremendous results cannot be achieved without shaving down, or that shaving down is the only way, but by and large I think most Docs and ESPECIALLY the surgical staff will agree that continual manipulation of the existing hair takes much longer and can create more shockloss.

 

In addition, the scalp looks much different under magnification, so when the recipient site is shaved it allows a Doc to reduce the risk of transection and work comfortably.

 

I don't know about you guys, but I want everything associated with my HT to easy and comfortable.

 

mrjb makes very valid points in regard to risk factors just as his argument about shaving down. Increased sessions sizes increase potential risk factors for complications......

ie-- If I hammer 3000 nails or 7000 nails, the greater risk of smashing my thumb occurs when I swing the hammer an additional 4000 times.

At this point, patient selectivity becomes paramount and for the Docs that are taking the Pepsi challenge for larger sessions, I think they are doing a better job qualifying patients in order to minimize risk.

Good Topic!

 

The fact of the matter is--- I know NOT shaving down can reduce session size, increase chances for transection, and increase potential for shockloss exponentially-------- IMO a better than logical argument for biting the bullent and pulling out the clippers!!!!!!

 

Great Topic Guys!!!!

[NervousNelly]

I don't know how anyone can argue that it is not better. We can try to convince ourselves otherwise.

 

Like myself, I don't think that I can shave my head with my profession unless I can find a way to take 1 month off. I realize that it is best for both the surgeon and myself but what is a guy to do?? I guess I could shave and go to work and possibly scare the shit out of everyone if I wanted to but not sure I'm ready for that. This is the last piece of the puzzle for myself in planning everything. Bottom line--I think its best but can I swing it??

[MrJobi]

NN

 

I'm in your boat too. I can't shave my head.. Now , keep in mind i've had 2 awesome HT's with Dr. True and was not required to shave my head (along with 90% of the coalition dr.'s...) Again, just beacuse it might make it easier to transplant does not mean it yeilds a better result.. These are two totally different thought processes. Ever thought it may just take a little more work and attention to detail for the doctor while transplanting? They have the micro-lenses and can clearly see the hair follicle . If it is markedly better why don't the majority of coalition docs require it? If it did produce a better result I'm sure they would request it as well. This is H & W's personal style. Some might argue H & W cuts their donor area rather high on the back of the head? Again, this is an opinion and other doctors might do it lower...Some say FUE is better than FUT. Does this mean all FUT docs are no good? At the end of the day it is wrong to discredit many great docs that don't specifically adhere to professional preferences of other docs (assuming they are using the most advanced FUT technologies).. This is true with other areas of medicine as well.. The proof is in the end result.. I have had 2 HT's with awesome results and a scar which is undetectable down to guard 2 ( never gone shorter).. Lastly, we must also take into consideration what the patient needs. I cant shave my head so guess what.. It's not a better method for me.

[nobuzz4me]

Mrjb and NN,

 

As you can see by my screen name, I would not go to any Doctor who requires you to shave down.

 

I am one week post op and it was no problem. They can still see the direction/angles of hairs and work between them. It is probably a little harder for the doctor and the techs who insert grafts but that is what they are paid for.

 

I do not have real long hair but it is long enough that my scar is undetectable and my recipient area is almost undetectable. It is a choice IMO of the doctor just as some might prefer staples over sutures. Either way can give you a good result. The argument about dense packing does not apply to many who would opt for a little more coverage for a little less density. Unless you have endless donor, which most do not, it is not really worth argueing about.

 

There are just too many great doctors out there who do not require it.

[the B spot]

JB--- no one is saying that tremendous results cannot be achieved by NOT shaving down, or that a dramatic difference exists between those who shave and those who don't.......

 

What I am saying is that shaving the recipient area provides the most OPTIMAL setting for performing a HT, that's all.

 

I think if you ask the Docs that don't "require shaving" that when push comes to shove, on larger sessions both Doc and Staff would prefer shaving the recipient area.

 

I think 1500 grafts or an exposed hairline/temple region would not require shaving, but that is my opinion only.

 

Anyway, for people like yourself or NN who simply cannot shave down, there is really no debate because the circumstances simply do not apply.

 

My statement is in regards to the optimal setting only.

 

Again, Great Discussion...........

[MrJobi]

Thanks Nobuzz

 

I would love to hear from some Coalition docs on this point other than H & W who has already stated their good case..Feller, True,Shapiro, Rose,any other to chime in. Nice to hear what the other 90% have to say to this point

 

???

[Bill - Seemiller]

Again, just beacuse it might make it easier to transplant does not mean it yeilds a better result..

 

This is a sticky statement...it's partly true and partly false. You are right...making things easier for the doc does not necessarily mean you WILL get a better result, but it MIGHT. Consider anything you do well. Let's take martial arts as an example (why...because I studied and took it for a long time and I can relate to it). Under what conditions could you perform the best? Under which conditions would it be more difficult for you to perform? Let's consider some variables in this example:

 

1. Mental or physical stressors (muscle tightness, tiredness, emotional issues, sickness)

2. Environment (atmosphere, lighting, spectators, judges)

 

Under which conditions could you perform the best? Chances are you perform better well rested, and the less emotional or physical issues, the better. Environment may be a personal choice as to what you like. We'll call any condition that may hinder your best performance "stressors".

 

Since surgery is not an exact science and is more of an art...why create unnecessary stressors for the doctor if they can be avoided? It's not that the doctor still can't perform his/her best...but why make it more difficult? Any added "stressors" have the POTENTIAL to hinder perfromance. This is a true statement no matter how anyone looks at it. I use the word potential here to show that it's not inevitable that one way will ALWAYS produce a better result than the other...but there are definite considerations why shaving your head is the BETTER option.

 

But again,

 

Many physicians have still proven, even without shaving the head, that they can still yield a superior result. BUT, I bet many of those same physicians would admit that shaving of the head would make make it easier, thus reducing a stressor.

 

Bill

[NervousNelly]

Well stated Bill. I can't add to that.

[MrJobi]

Thats a good point Bill

 

However, we can use this resonsing for a doctor performing a mega session as well. Placing 6000 HT's or more in a 11 hour day is quite a task. If we were to look at a graph of performance you would see as work time increases performance decreases. You can see this is sports especially. So could we also say you Might get a better result if you break it into 2 sessions of 3000 to avoid fatigue??? In addition, the docs tech or one who places the hairs in the holes also has to cut them so we are dealing with eye and hand performance.. So all the advantages you may get with shaving may be a wash due to fatigue...

 

I'd love to hear from a professional on all topics we taked about..

 

thanks for the mental jousting

[Bill - Seemiller]

Mrjb,

 

Good point. Yes, adding more work does mean the possibility that an additional stressor could potentially be added "fatigue". Typically to help avoid fatigue, however, clinics have multiple techs doing multiple tasks. The only real added work that could cause additional fatigue would be making extra incisions ex: 3000 verses 6000. But yes, there is additional and longer concentration needed to do larger surgeries which is another reason why it's important to choose a doctor who has proven themselves to be effective. And it's the same thing with shaving verses non-shaving.

 

Good discussion.

 

Bill

[nobuzz4me]

I think the bottom line here is that if you choose an experienced, top doctor, they are very good at handling any of these stresses. Whether the stress comes form long hours, many tight work between hairs, etc., these guys are all professionals and can handle the job. I would love to hear from the doctors on this though, would be very informative.

 

On another tangent, Dr. Cooley, I understand, puts a surgical cap over his patients post op to pump oxygen in during recovery. If this really makes a difference, wouldn't everyone adapt? Again, this is an example of a doctor who has a preference which may or may not make a real difference in the final outcome, who can tell?

[MrJobi]

Yes,

 

It's like running backs in the NFL ... Each has their own style.. Who was the best ever?? Who knows, but that is my point... Just because 1 runner has superior speed does not mean he is better, it's a talent ( or personal style)..

For us to say if he's not super fast he's no good would be like saying, if a doc doesn't have a particular preference, he's not as good

 

that's it for now

[Bill - Seemiller]

I have nothing more to add...would love to hear a docs opinion

 

Bill

[Salt-N-Peppa]

FWIW, I just had my second HT with Dr Hasson a few days ago, in the consultation he asked if I wanted the recipient area shaved. I had no problem with it at all. Anything to help get a better result. The point is that I was asked though, I don't believe that Dr Hasson ( I don't know Dr Wong) has absolutes regarding shaving the donor site. Cheers, S-n-P

[nobuzz4me]

Wow, that is interesting, I thought it was required for the optimum result. I think he will get more business if more know he is flexible on this. He probably does not need the business though, with his reputation.

 

I think H&W, Feller seem to do the largest sessions which makes them so attractive. If they are optional with the shaving, I would consider them for sure.

[Bill - Seemiller]

Salt-N-Peppa,

 

That is interesting that you were asked...I wasn't asked. But I went in with the assumption/knowledge that I was going to be shaved. One of the reasons I didn't go to him the first two surgeries was because I was reluctant to go to anyone who required shaving...but the more I learned about Dr. Hasson and the more of his results I saw, I became convinced that dealing with the shaving of the head is minimal if I can get an outstanding lifelong result!

 

Maybe he doesn't require it anymore? Either way...if a doc asked me the question, I would probably ask...what he thinks is best and then go with his advice. Hmmm.

 

Bill

[MrJobi]

Hi Guys

 

He does require shaving. I had a email consult with one of his people ( I think it was Jotronic) and this was my main concern. They said the only way they would not shave it if they were to do very small sessions. I can go to any coalition doc to have large sessions so there was no point.. I respect his preference for the shaving as it is his method. With that being said, it doesn't work for some patients

[Bill - Seemiller]

Mrjb,

 

What Salt-N-Peppa was saying is he was asked if he wanted to be shaved. One could assume that means he had a choice. Perhaps he changed his policy since your last consult? Or perhaps each patient is taken case by case? Perhaps it was a rhetorical question...I don't know.

 

Bill

[Dr. Jerry Wong]

We do realize that it is not possible for everyone to shave their hair. Patients who wants or requires up to 2400 grafts do not have to shave. However if dense packing is desired in the central area of the crown swirl and the first 3 to 4 mm. of the hairline then I can do a better job if these areas are shaved. Between 2400 to 3000 grafts we may or may not have to shave. I personally will not atttempt to do 3000+ grafts without shaving.

The recipient site is not shaved down to the skin, rather the hair is cut down to 2mm. which allows me to see the exit angle of the existing hair which in turn allows me to judge the resting hair angle underneath the skin. When making lateral slits it is crucial that the blade shaft angle matches the follicular angle under the skin to prevent transection of existing follicles. Using lateral slits and aligning the slit angle to the existing hair also allow a seamless blend of transplanted to existing hair. If the recipient hair is long it much harder to see the hair's true exit angle and thus harder to judge the folicular angle under the scalp. Under these circumstances most doctors will then use sagital slit in these areas to reduce transections but sagitals will not control hair angle as well as laterals and the transplanted hair will not blend quite as well to the existing hair.

It is possible to get great results by not shaving and doing smaller surgeries and we will work with you if that is your desire. But the really breath taking results have been when we can optimize the working condition in order to dense pack large sessions using lateral slits

[MrJobi]

Thanks Dr. Wong

 

We realize how busy you are.. This is news to me as I believe I might have been informed diffferently during my e-consult. BUT, in his defense, maybe it was based on my pictures that I sent for diagnosis? Basically, I need to fill in the mid and crown areas. There is no way I will need more than 2400. Maybe I will re visit with your team .. Bill , I dunno, I spoke the H & W about 1 or 2 ago.. It could be my situation??

 

Thanks again

[Salt-N-Peppa]

There you have it, I was asked by Dr Hasson if I wanted to be shaved, I knew from my first HT(4944FU's) with him what his preference was and more importantly the better results were obtained by shaving (specifically the angle that the transplanted hair lies with the neighboring hairs). I definately was looking at the long term solution to my hair loss and deferred to the judgemant of the pros. My second HT resulted in 1960FU's all being placed in basically minimal hair areas, perhaps this is why I was offered a choice of shave/no shave. Again, if there was anything I could do to help facilitate a better HT, I was going to do it. Therefore I said to shave my head.Cheers, S-n-P

[Bill - Seemiller]

Dr. Wong,

 

Thank you for your response. That definitely clears things up a bit regarding your clinic's decision to shave the recipient area...and as I said...there seems to be a strong case for it's benefits, especially for larger sessions. Thanks for posting on this forum!

 

Bill

[NervousNelly]

Thanks for replying doc. Your stock just went up.